496803241-10-3-2023-21-AS-BMOS-CWFPHC-20231009111943

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803241
Report Date: 10/03/2023
Date Signed: 10/03/2023 11:41:14 AM

Unsubstantiated

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
07/14/2023 and conducted by Evaluator Victoria Bertozzi

COMPLAINT CONTROL NUMBER: 21-AS-20230714123714

FACILITY NAME:	BROOKDALE CHANATE		FACILITY NUMBER:	496803241
ADMINISTRATOR:	LEDESMA, KATELYN		FACILITY TYPE:	740
ADDRESS:	3250 CHANATE RD		TELEPHONE:	(707) 575-7503
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	140	CENSUS: 106	DATE:	10/03/2023
		UNANNOUNCED	TIME BEGAN:	08:44 AM
MET WITH:	Administrator, Katelyn Ledesma		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Facility did not meet resident's needs
Facility did not follow resident's care plan
Facility did not respond to call buttons
Facility staff did not ensure that resident received warm food
Facility did not properly respond to resident's injuries

INVESTIGATION FINDINGS:

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Licensing Program Analysts Bertozzi and Coppo arrived unannounced to complete complaint investigation regarding the above allegations and met with Administrator, Katelyn Ledesma.

Facility did not meet resident's needs, Facility did not follow resident's care plan – Complaint alleges that resident requires assistance with meals and catheter care in the form of the catheter bag being emptied and meals being delivered. Per complainant, the catheter bag was to be emptied three times per day and there were multiple occasions where the catheter bag was not emptied timely noting two occasions where the resident’s catheter came out requiring a nurse to come to the facility and re-insert the catheter. Complainant reported that the catheter may have come out as a result of the bag being overfull. Per interview with individual involved with resident’s care, the catheter line could have come out from the catheter bag being overfull but it is not clear if that was the reason in this case.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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-20230714123714

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: BROOKDALE CHANATE	FACILITY NUMBER: 496803241
	VISIT DATE: 10/03/2023

NARRATIVE

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Continued from LIC9099

Review of resident’s care plan states that the bag should be emptied twice daily or as needed. Interviewed staff denied not emptying catheter bag timely with some stating that resident had increased urinary output. Pictures provided show a full catheter bag but it is not clear if it was because of increased urinary output or if facility staff were not emptying bag timely. Per complaint, there was an incident where resident did not wake up until the afternoon resulting in resident not having breakfast and lunch and not having their catheter bag emptied. Additionally, facility staff are not clearing away disposable containers after meals. Interviews provided conflicting information about whose responsibility it is to clear containers. Complaint also alleges that resident missed meals due to them not being delivered. LPA was unable to confirm. Per staff interview, residents are woken up for meals.

Facility did not respond to call buttons – Complaint alleges that resident used the call button on several occasions and there was no response. LPA attempted to obtain call button records but was unsuccessful. Per interviews, resident frequently contacted their responsible party instead of using the call button system.

Facility staff did not ensure that resident received warm food - Complaint alleges that staff did not take into account resident’s vision restraints and notify resident that meals were being left for them, resulting in resident having cold food. Per staff interview, dining staff were not initially notifying resident, R1 when they dropped off a meal but once the issue was brought to their attention, dining staff started to notify R1. Per interview, there is a microwave in the resident’s room and caregivers would heat up meal for resident, as needed.

Facility did not properly respond to resident's injuries – Complaint alleges that resident was observed with a wound on their arm by a family member and when the resident was brought to the reception area the receptionist stated they did not have a First Aid Kit. Per chart notes a Medication Technician came and provided first aid to the resident.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

No deficiencies cited.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC9099 (FAS) - (06/04)

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