486803710-7-30-2021-21-AS-HDBI-C69TA6-20210826143301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803710
Report Date: 07/30/2021
Date Signed: 07/30/2021 05:59:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/28/2021 and conducted by Evaluator Katrina Walters

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20210628163331

FACILITY NAME:	PARAMOUNT HOUSE SENIOR LIVING		FACILITY NUMBER:	486803710
ADMINISTRATOR:	SIOBHAN LEHMAN		FACILITY TYPE:	740
ADDRESS:	2061 PEABODY RD		TELEPHONE:	(707) 455-0300
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	95	CENSUS: 83	DATE:	07/30/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Richard Remigio		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff are not adequately trained.

INVESTIGATION FINDINGS:

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On 7/30/21 at approximetely 1:30 PM Licensing Program Analyst (LPA) Walters arrived at this facility unannounced and met with Administrator, Richard Remigio. The purpose of this visit is to deliver findings for the above allegation.

On 6/28/21 the Department received a complaint alleging that Staff are not properly trained, more specifically that medication technician do not have proper training to distrubute medication. LPA investigated this complaint, which involved a review of 5 staff training records, timesheets, staffing schedules and the facilities program plan.

Facility was not able to provide verification that all required training has been completed for 5 of 5 staff. Request were made on 7/1/21 and during today's visit. The Administrator stated that they were unaware of where the other staff training records were. (Continued on 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina Walters	TELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

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-20210628163331

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: PARAMOUNT HOUSE SENIOR LIVING	FACILITY NUMBER: 486803710
	VISIT DATE: 07/30/2021

NARRATIVE

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Based on interviews and a review of staff records, LPA Walters determined that staff are not adequately trained, therefore the allegation is SUBSTANTIATED.

A finding that the staff are not adequately trained is substantiated meaning that the allegations is valid because the preponderance of the evidence standard has been met. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation on 9099-D. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina Walters	TELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20210628163331

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: PARAMOUNT HOUSE SENIOR LIVING	FACILITY NUMBER: 486803710
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/30/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/09/2021 Section Cited CCR 87411(d)(4)	1 2 3 4 5 6 7	87411 Personnel Requirements (d)All personnel shall be given on the job training..as appropriate for the job assigned..(4) Knowledge required to safely assist with prescribed medications..This requirement is not met as	1 2 3 4 5 6 7	Licensee/Administrator will ensure all staff have all required training. Administrator to provide proof of on the job trainnig for all med-techs to CCL Rohnert Park attention LPA Walters by POC due date 8/9/21.
	8 9 10 11 12 13 14	evidenced by: Based on record review and interview the licensee did not comply with the section cited above, the Administrator did not provide verification of staff training for 5 out of 5 staff.which poses an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina Walters	TELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

LIC9099 (FAS) - (06/04)

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