496801635-6-3-2021-21-AS-HDBI-C3UVJE-20210610162836

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496801635
Report Date: 06/03/2021
Date Signed: 06/03/2021 03:18:40 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
02/11/2021 and conducted by Evaluator Victoria Willis

COMPLAINT CONTROL NUMBER: 21-AS-20210211100606

FACILITY NAME:	HEALDSBURG SENIOR LIVING COMMUNITY		FACILITY NUMBER:	496801635
ADMINISTRATOR:	MEASE, TRACEY		FACILITY TYPE:	740
ADDRESS:	725 GROVE STREET		TELEPHONE:	(707) 433-4877
CITY:	HEALDSBURG	STATE: CA	ZIP CODE:	95448
CAPACITY:	82	CENSUS: 34	DATE:	06/03/2021
		UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Executive Director, Tracey Mease and Resident Service Director, Tru Coiner		TIME COMPLETED:	03:18 PM

ALLEGATION(S):

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Facility failed to provide adequate care and supervision
Resident was not provided clean linen

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Willis and Erik Gonzalez-Campos arrived unannounced, deliver findinngs regarding the above-mentioned complaint allegation and met with Executive Director, Tracey Mease and Resident Service Director, Tru Coiner.

During investigation LPA conducted interviews and reviewed documents and pictures. Facility failed to provide adequate care and supervision – Complaint alleges that residents who were in the Memory Care Unit during a Covid Outbreak were not provided care and supervision including but not limited to: not abiding by Covid-19 infection control precautions, pillows not being provided to residents in order to float heels resulting in pressure injuries, hospice resident’s oral hygiene not being met and resident’s wound care not being provided. Covid-19 infection control issues with this facility were previously addressed over multiple visits in December 2020 and January 2021. Additionally, it was confirmed that the facility was having staffing issues at that time and the facility was issued a plan of correction.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Willis	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

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-20210211100606

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: HEALDSBURG SENIOR LIVING COMMUNITY	FACILITY NUMBER: 496801635
	VISIT DATE: 06/03/2021

NARRATIVE

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Continued from LIC9099

Based on interviews, pillows were not always available for floating heels but staff used other items to float heels including rolled up towels. While some interviews indicated that heels were floated consistently, others indicated they weren’t. LPA was unable to obtain sufficient evidence to confirm whether or not oral hygiene and wound care were being provided.

Resident was not provided clean linen – Complaint alleges that laundry was not being done resulting in a resident having no clean linens and the facility using a fitted sheet and a mattress cover as a blanket because there were no blankets. Pictures were reviewed by LPA that included bags of linens and a bed with soiled linens and a stained mattress. Interviews revealed that at one point linens were being washed in the Skilled Nursing section of the facility causing a delay but interviews denied other items being used as blankets. Interviews revealed a resident who was incontinent and would frequently have soiled linen indicating that when linens are soiled, they are immediately cleaned. LPA was unable to confirm that all caregivers followed this protocol.

A finding that the complaint allegation that facility failed to provide adequate care and supervision and that resident was not provided clean linen was unsubstantiated meaning that although the allegations may have happened there is not a preponderance of evidence to prove that the allegation occurred. We have therefore dismissed the complaint.

No deficiencies cited during this inspection.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Willis	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

LIC9099 (FAS) - (06/04)

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