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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507002685
Report Date: 09/20/2023
Date Signed: 09/20/2023 02:49:02 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/01/2023 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20230301163001
FACILITY NAME:ST. FRANCIS ASSISTED CAREFACILITY NUMBER:
507002685
ADMINISTRATOR:JAMI YOUNGFACILITY TYPE:
740
ADDRESS:120 TWENTIETH CENTURY BLVDTELEPHONE:
(209) 668-8014
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY:56CENSUS: 38DATE:
09/20/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Office Manager Dawn PeroTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff do not provide adequate supervision to residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Jason Lund arrived at the above facility to complete a complaint investigation. LPA Lund met with Office Manager Dawn Pero and explained the reason for the visit.

Staff do not provide adequate supervision to residents in care- Based on LPA Lund interviews with staff, RP, and facility paperwork. LPA Lund reviewed Resident’s (R1) LIC602A dated 3/28/2022 stating that R1 ambulatory status is bedridden. The facility license (LIC203A) for St. Francis Assisted Care effective date 7/31/2006 doesn’t have a fire clearance granted for bedridden residents.


Substantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
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 7
Control Number 27-AS-20230301163001
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: ST. FRANCIS ASSISTED CARE
FACILITY NUMBER: 507002685
VISIT DATE: 09/20/2023
NARRATIVE
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Based on LPA interviews, review of facility paperwork the preponderance of evidence has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6 & Chapter number 8) is being cited on the attached LIC 9099D.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 27-AS-20230301163001
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ST. FRANCIS ASSISTED CARE
FACILITY NUMBER: 507002685
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/21/2023
Section Cited
CCR
87468.1(a)(2)
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Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
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The resident moved out of the facility.
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Requirement has not been met as evidenced by: Records show the facility doesn’t have a fire clearance for bedridden residents. This poses an immediate health, safety, or personal rights risk to residents in care.
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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: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/01/2023 and conducted by Evaluator Jason Lund
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230301163001

FACILITY NAME:ST. FRANCIS ASSISTED CAREFACILITY NUMBER:
507002685
ADMINISTRATOR:JAMI YOUNGFACILITY TYPE:
740
ADDRESS:120 TWENTIETH CENTURY BLVDTELEPHONE:
(209) 668-8014
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY:56CENSUS: 38DATE:
09/20/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Office Manager Dawn PeroTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Resident sustained UTI's while in care
Illegal eviction
Staff do not ensure facility is free of cigarette smoke
Staff does not ensure resident is provided adequate food service
Staff does not ensure resident is provided water
Staff does not ensure resident's urine is properly disposed
Staff does not meet resident's grooming/showering needs
Staff does not ensure facility floors are clean
INVESTIGATION FINDINGS:
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Resident sustained UTI's while in care- Based on interviews with staff, reporting party, witness and records review. LPA Lund reviewed Resident’s (R1) LIC602A dated 3/28/2022 stating that R1 has many health conditions such as prostate enlargement, constipation and the use of a catheter. Interview with in-home healthcare stated that they treated R1’s incontinence care twice a week while R1 was at the facility. The in-home healthcare also trained staff in foley catheter placement care. Facility records show that R1 was sent out to the Emergency room when requested by R1.
Based on interviews with staff, reporting party, witness and records review the information provided, it was unclear if resident sustained UTI's while in care therefore the allegation was deemed UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 27-AS-20230301163001
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: ST. FRANCIS ASSISTED CARE
FACILITY NUMBER: 507002685
VISIT DATE: 09/20/2023
NARRATIVE
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Illegal eviction - Based on records review, interviews with staff and reporting party. Resident (R1) power of attorney (POA) signed out R1 on 2/27/2023 without given a 30- day notice. The facility waived 30-day notice and POA signed R1’s out of the facility along with R1’s medication count sheet dated 2/27/2023.

Based on facility records review, interviews with staff and reporting party the information provided, it was unclear if Illegal eviction therefore the allegation was deemed UNSUBSTANTIATED.

Staff do not ensure facility is free of cigarette smoke- Based on interviews with staff, residents in care, reporting party and observation. The facility smoking area is 20 feet from the facility. Staff interviewed stated that they have not smelled any cigarette smoke inside the facility. Residents in care stated that they have not smelled any cigarette smoke inside the facility. LPA’s Lund didn’t smell any cigarette smoke on facility visits 3/8/2023, 7/12/2023 & 9/20/2023.

Based on interviews with staff, residents in care, reporting party and observation the information provided, it was unclear if staff do not ensure facility is free of cigarette smoke therefore the allegation was deemed UNSUBSTANTIATED.

Staff does not ensure resident is provided adequate food service - Based on records review, interviewed with staff, residents in care and reporting party. Resident’s (R1) LIC602A dated 3/28/2022 stating that R1 is able to feed self. LPA Lund observed sufficient 7-day non- perishable and 2-day perishable food at the facility. Staff interviewed stated that R1 was able to feed self and would encourage R1 when needed to eat.

Based on records review, interviewed with staff, residents in care and reporting party the information provided, it was unclear if staff does not ensure resident is provided adequate food service therefore the allegation was deemed UNSUBSTANTIATED.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 27-AS-20230301163001
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: ST. FRANCIS ASSISTED CARE
FACILITY NUMBER: 507002685
VISIT DATE: 09/20/2023
NARRATIVE
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Staff does not ensure resident is provided water- Based on interviews with staff and residents in care, reporting party and observation. LPA Lund observed that resident in care were provided water. Residents interviewed stated that they were given water when needed. Staff interviewed would give water on request and would encourage residents in care to drink water.

Based on interviews with staff and residents in care, reporting party and observation the information provided, it was unclear if staff does not ensure resident is provided water therefore the allegation was deemed UNSUBSTANTIATED.

Staff does not ensure resident's urine is properly disposed- Based on records review, interviews with staff, witness and reporting party. Records show that the facility staff was trained by home health on how to properly dispose of R1’s urine. Staff interviewed stated that they would only empty out the catheter and home health would change the catheter. Home health staff reported that staff would come twice a week to check the status of R1.

Based on records review, interviews with staff, witness and reporting party the information provided, it was unclear if staff does not ensure resident's urine is properly disposed therefore the allegation was deemed UNSUBSTANTIATED.

Staff does not meet resident's grooming/showering needs- Based on records review, interviews with staff, witness, reporting party and clients in care. Residents (R1) Activities of Daily Living Logs (ADLS) form December 1, 2022, through February 27, 2023 stated that R1’s needs were being met. Residents interviewed stated there ADLS are being take care of by staff are independently.

Based on records review, interviews with staff, witness, reporting party and clients in care the information provided, it was unclear if staff does not meet resident's grooming/showering needs therefore the allegation was deemed UNSUBSTANTIATED.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 27-AS-20230301163001
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: ST. FRANCIS ASSISTED CARE
FACILITY NUMBER: 507002685
VISIT DATE: 09/20/2023
NARRATIVE
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Staff does not ensure facility floors are clean- Based on records review. interviews with staff, reporting party, residents in care and observation. The facility floors were clean on LPA’s Lund facility visits 3/8/2023, 7/12/2023 & 9/20/2023. Records indicate the facility has housekeeping clean seven days a week and staff when necessary. Housekeeping interviewed stated that they clean floors daily and when necessary. Staff interviewed stated that they clean floors when necessary.

Based on records review, interviews with staff, reporting party, residents in care and observation the information provided, it was unclear if staff does not ensure facility floors are clean therefore the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

The following deficiencies are cited per California Code of Regulations, TITLE 22. Exit interview was conducted and a copy of this report, and appeal rights were left at the facility.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7