486803710-12-6-2024-21-AS-BMOS-DBZRGW-20241216120124

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803710
Report Date: 12/06/2024
Date Signed: 12/06/2024 05:56:59 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/30/2024 and conducted by Evaluator Julie Florio

COMPLAINT CONTROL NUMBER: 21-AS-20240930151325

FACILITY NAME:	PARAMOUNT HOUSE SENIOR LIVING		FACILITY NUMBER:	486803710
ADMINISTRATOR:	CANDICE MOSES		FACILITY TYPE:	740
ADDRESS:	2061 PEABODY RD		TELEPHONE:	(707) 455-0300
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	95	CENSUS: 69	DATE:	12/06/2024
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Agustin Samaniego, Executive Director		TIME COMPLETED:	06:05 PM

ALLEGATION(S):

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Staff are not answering residents' call buttons in a timely manner.
Staff are not meeting residents’ bathing needs.

INVESTIGATION FINDINGS:

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On 12/06/2024, at approximately 4:30 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to deliver findings for the above allegations. Reporting Party (RP) alleges that staff are not answering residents' call buttons in a timely manner and staff are not meeting residents’ bathing need, which are both SUBSTANTIATED.

LPA conducted 10-day on 10/02/2024 for complaint #21-AS-20240930151325 which was received by The Department on 09/30/2024 and made observations, conducted interviews, and obtained documents. LPA interviewed Resident 2 (R2), Resident 3 (R3), and the Resident Services Director (RSD) which revealed that R2 and R3 have on multiple occasions waited extended periods of time after pushing their call pendants before receiving staff assistance.

Continued on LIC9099C...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Julie Florio	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20240930151325

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: PARAMOUNT HOUSE SENIOR LIVING	FACILITY NUMBER: 486803710
	VISIT DATE: 12/06/2024

NARRATIVE

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Continued from LIC9099...

Documents obtained confirmed that over a 4-month period, R2 waited 15 minutes or more 91 times before receiving staff assistance, 23 of which were for wait times greater than 30 minutes, and 5 were for wait times greater than 60 minutes. Additionally, interviews with Resident 2 (R2) and Resident 3 (R3) revealed that during the months R1 received bathing care from facility, they asked for their baths and did not receive the 2 baths per week as agreed to in their admissions contract. Upon review of R1’s bathing records, R1 received a documented 20 baths over the course of 5 months, which amounts to approximately 1 bath per week and is less than the 2 baths per week indicated in R1’s admissions agreement. LPA was unable to obtain documentation that R1 refused baths.

Based on interviews conducted, observations made, and record review, the allegations listed above are SUBSTANTIATED. A finding that complaint allegations are substantiated means that the allegations are valid because the preponderance of the evidence standard has been met, therefore the allegations are SUBSTANTIATED.

The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6.

Exit interview conducted. Copy of report discussed and provided to Licensee, whose signature on form confirms receipt of documents. Appeal Rights Provided.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Julie Florio	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20240930151325

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: PARAMOUNT HOUSE SENIOR LIVING	FACILITY NUMBER: 486803710
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/06/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/09/2024 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	Basic Services 87464(f) (4) Personal assistance and care...as indicated in the pre-admission appraisal, with those activities of daily living such as...bathing…. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	LIcensee to submit self-certification that staff will be coached on and facility will ensure that bathing and refusals are documented for the contracted number of baths indicated in residents' admissions agreements. Licensee to submit to CCL by POC due date of 12/9/2024.
	8 9 10 11 12 13 14	Based on record review and interviews, R1 received a documented 20 baths over the course of 5 months, which amounts to approximately 1 bath per week and is less than the 2 baths per week indicated in R1’s admissions agreement.	8 9 10 11 12 13 14
Type A 12/09/2024 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	Personnel Requirements – General: 87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs… This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee to submit self-certification to CCL stating that all care staff have will be coached on the facility's call response requirements and procedures for triaging response when unable to respond personally. Licensee to submit this to CCL by POC due date of 12/09/2024.
	8 9 10 11 12 13 14	Based on interviews and record review, facility failed to ensure timely response to residents' calls for assistance in over 91 instances within a 9-month time frame. This posed an immediate health, safety, and personal rights violation to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Julie Florio	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

LIC9099 (FAS) - (06/04)

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