515002765-4-18-2022-25-AS-LMUZ-CDNQ42-20220420114937

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 515002765
Report Date: 04/12/2022
Date Signed: 04/18/2022 08:02:35 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2021 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 25-AS-20210722143123

FACILITY NAME:	EMERALD OAKS		FACILITY NUMBER:	515002765
ADMINISTRATOR:	BAINS, GURPRIT		FACILITY TYPE:	740
ADDRESS:	2290 FORREST LANE		TELEPHONE:	(530) 751-0511
CITY:	YUBA CITY	STATE: CA	ZIP CODE:	95993
CAPACITY:	116	CENSUS: 65	DATE:	04/12/2022
		ANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	IVY GARNER		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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A resident is being transferred from bed to toilet in an unsafe manner.
Resident was left in bed in her own urine.

INVESTIGATION FINDINGS:

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Donna Gurriere, Licensing Program Analyst was in contact and met with Ivy Garner, Assistant Administrator. It was alleged that A resident is being transferred from bed to toilet in an unsafe manner and Resident is being left in her bed in her own urine.

LPA Gurriere completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID 19 infection to affirm no COVID-19 related symptoms. The administrator/staff person was contacted to complete a facility risk assessment. LPA Gurriere ensured that hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. Additionally, LPA Gurriere was screened by a staff person upon entering the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

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 25-AS-20210722143123

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: EMERALD OAKS	FACILITY NUMBER: 515002765
	VISIT DATE: 04/12/2022

NARRATIVE

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A resident is being transferred from bed to toilet in an unsafe manner.

During the investigation process the assistant administrator and five staff persons were interviewed. In addition, the resident (Resident 1) was interviewed. Documentation was received and reviewed to include the Physician’s Report, Admission Agreement, How to use a Hoyer Lift requirement and a Hoyer Lift Inservice Signoff document.

During the initial visit at the facility, Misty Valencia and Dawn Keene, two Licensing Program Analysts (LPAs) went to the resident’s room to view the concern of the Hoyer Lift being moved from the resident’s bed to the bathroom. It was reported and observed by the LPAs that the threshold was at a “normal height.” All staff persons reported that there was not a problem with using the Hoyer Lift with the resident and that the Hoyer Lift was always used with two staff persons assisting. The resident was interviewed, and she reported that she felt “safe” when the staff persons were using the Hoyer Lift. There was no report that an incident occurred with a transfer in an unsafe manner. Records were received and reviewed indicating that staff have been trained in using a Hoyer Lift.

It could not be proven that A resident is being transferred from bed to toilet in an unsafe manner. Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

continued

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20210722143123

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: EMERALD OAKS	FACILITY NUMBER: 515002765
	VISIT DATE: 04/12/2022

NARRATIVE

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Resident left in bed in her own urine.
During the investigation process the assistant administrator and five staff persons were interviewed. The resident (Resident 1) was not interviewed, as she is no longer residing at the facility. Documentation was received and reviewed to include the Physician’s Report and Admission Agreement.

It was reported that the resident needed assistance in incontinence issues. All staff persons advised that they were not aware that the resident was left in bed in her own urine, as the resident was on an incontinence schedule that they followed.

It could not be proven that A resident was left in her bed in her own urine. Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

Although it was not indicated that the resident was left in bed in her own urine, the staff are required to follow a bowel and bladder program developed by a skilled professional. The staff have indicated that they followed a schedule; however, the staff have not been trained by a skilled professional, as required. Based on this information, the facility shall be cited on a separate report, LIC 809, on this date. (See LIC 809).

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

LIC9099 (FAS) - (06/04)

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