502700636-11-2-2023-27-AS-KHOS-CXBPDL-20231106101343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700636
Report Date: 11/02/2023
Date Signed: 11/02/2023 11:36:09 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/03/2023 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230703105055

FACILITY NAME:	GROVE, THE		FACILITY NUMBER:	502700636
ADMINISTRATOR:	GAITHER, NICK		FACILITY TYPE:	740
ADDRESS:	2801 LOU ANN DRIVE		TELEPHONE:	(209) 575-1950
CITY:	MODESTO	STATE: CA	ZIP CODE:	95350
CAPACITY:	74	CENSUS: 33	DATE:	11/02/2023
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Chris Gaither		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Staff did not prevent an outbreak of scabies.
Staff handles residents in a rough manner.
Staff yells at residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Chris Gaither and explained the purpose of the visit.

This investigation consisted of interviews, observations, and record review.

During interviews, Gaither and five staff members (S1, S2, S3, S4, S6) said there was not an outbreak of scabies at the facility. One staff member (S5) said they were not sure if there was a scabies outbreak or not, but said a few residents did have a rash. Of six residents interviewed (R1-R6), R1 and R6 were unable to answer questions regarding scabies, R2 and R4 were not aware of any scabies, and R3 and R5 said R1 had scabies.

[continued on 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

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

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 27-AS-20230703105055

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: GROVE, THE	FACILITY NUMBER: 502700636
	VISIT DATE: 11/02/2023

NARRATIVE

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LPA Moleski reviewed R1’s file and observed multiple medical records dating from March 2023 through October 2023 diagnosing R1 with an unspecified, itchy rash. LPA Moleski reviewed medical records for two other residents (R7, R8). R7 was prescribed an antihistamine for itchy spots, and R8 was diagnosed with a dry skin rash. LPA Moleski did not observe any skin rashes on residents other than R1.

During an interview, R1’s responsible party said R1 has not had scabies.

LPA Moleski interviewed six staff members (S1-S6). Of these, all six staff members denied that staff are rough with residents and denied that staff yell at residents. S1 and S5 said staff sometimes do have to speak louder for residents who are hard of hearing. LPA Moleski interviewed six residents (R1-R6). R2 said one staff member was too rough with R2. LPA Moleski interviewed R2’s responsible party, who said that R2 exaggerated the incident described. R3 said staff sometimes yell at residents if residents are yelling at them. R4 said staff sometimes yell at residents to get their attention, but said staff do not yell in a mean way. R5 said one staff member yells at R5.

The department has determined the following as it relates to the allegations that staff did not prevent an outbreak of scabies, that staff handle residents in a rough manner, and that staff yell at residents:

Based on observation, record reviews, and interviews, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was left with Gaither.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/03/2023 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230703105055

FACILITY NAME:	GROVE, THE		FACILITY NUMBER:	502700636
ADMINISTRATOR:	GAITHER, NICK		FACILITY TYPE:	740
ADDRESS:	2801 LOU ANN DRIVE		TELEPHONE:	(209) 575-1950
CITY:	MODESTO	STATE: CA	ZIP CODE:	95350
CAPACITY:	74	CENSUS: 33	DATE:	11/02/2023
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Chris Gaither		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Staff did not seek timely medical attention for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Chris Gaither and explained the purpose of the visit.

This investigation consisted of interviews, observation, and record review.

LPA Moleski interviewed a resident (R1). R1 could not recall having any skin conditions or receiving treatments. LPA Moleski observed a rash on R1’s legs with minor bleeding. LPA Moleski did not observe blood in R1’s bedsheets or on R1’s clothing.

[continued on 9099-C]

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 27-AS-20230703105055

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: GROVE, THE	FACILITY NUMBER: 502700636
	VISIT DATE: 11/02/2023

NARRATIVE

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LPA Moleski reviewed R1’s file. Facility staff were aware of this rash since at least March 2023, based on a dermatologist’s prescription for medication to treat this rash dated 3/27/23. Following this date, LPA Moleski observed three after-visit summaries from medical appointments regarding this rash and three further prescriptions made by dermatologists addressing the treatment of R1’s rash. LPA Moleski reviewed R1’s MARs and observed that R1 had been receiving the medications prescribed.

During interviews, Gaither and two care staff members (S1-S2) said R1 had been treated for the rash, but said that doctors were unable to determine the cause of the rash and that medications had not been very effective. A third care staff member (S3) was aware of the rash but did not handle any facility medications, so could not say what treatments had been given to R1.

During an interview, R1’s responsible party (RP) said that although medications have not been effective, R1 has received medical attention for the rash. R1’s RP did not have any concerns regarding the facility.

The department has determined the following as it relates to the allegation that staff did not seek timely medical attention for resident:

Based on interviews and record review, the above allegation is UNFOUNDED. A finding that the complaint allegation is unfounded means the allegation is false, could not have happened or is without a reasonable basis.

No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Gaither.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent Moleski	TELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4