525002662-7-28-2020-25-AS-RLBN-BS5T3C-20200803142207

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525002662
Report Date: 07/28/2020
Date Signed: 07/28/2020 09:34:04 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/21/2020 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 25-AS-20200621085623

FACILITY NAME:	BROOKDALE RED BLUFF		FACILITY NUMBER:	525002662
ADMINISTRATOR:	MATLOCK, ESMERALDA		FACILITY TYPE:	740
ADDRESS:	705 LUTHER ROAD		TELEPHONE:	(530) 529-2900
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY:	0	CENSUS: 52	DATE:	07/28/2020
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	SUSAN TODD		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Care and Supervision – Staff failed to meet the needs of a resident.

INVESTIGATION FINDINGS:

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Donna Gurriere, Licensing Program Analyst (LPA) was in contact with Susan Todd, Wellness Director. A physical visit could not be made due to the orders in place regarding the Covid 19 Virus. It was alleged that staff failed to meet the needs of a resident.

An investigation was conducted and during that time, several documents regarding the resident were obtained and reviewed to include: Physician’s Report, Residency Agreement, Schedule of Services and Rates, Incident Report and Progress Notes.

Care and Supervision – Staff failed to meet the needs of a resident. The administrator, the nurse, several staff persons and some residents were interviewed. Staff persons reported that the resident was sent to the hospital with possible dehydration and a bowel blockage. Staff persons advised that the resident took care of her own colostomy bag with minimal assistance and that she was “Independent Minded” in taking care of her own needs. This was supported by the Physician's Report which indicated that the resident could "Care for her own toileting needs."
***continued***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2020

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-20200621085623

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 COHASETT RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BROOKDALE RED BLUFF	FACILITY NUMBER: 525002662
	VISIT DATE: 07/28/2020

NARRATIVE

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***continued***

Staff persons stated that for the resident’s diet, she was offered three meals a day, which included snacks, protein shakes and various liquids.

Residents were interviewed and they reported that staff persons and the nurse were able to meet their needs while residing at the facility. Residents further advised that there is a variety of food provided and that the cook has met with them to discuss their food choices.

On 06/12/20 the resident requested to go to the hospital, as she was feeling dizzy, light-headed and thought that she was dehydrated. The resident was admitted to the hospital with failure to thrive, bowel obstruction, hydronephrosis, anxiety, hyponatremia and protein calorie malnutrition.

Although the resident had numerous medical issues, she was offered daily assistance with care and supervision and she was given three meals a day, which included snacks, protein shakes and various liquids. After a three day stay at the hospital, resident was transported to a rehabilitation facility.

Based on the information obtained and interviews conducted, the above allegation is Unsubstantiated. 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.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2020

LIC9099 (FAS) - (06/04)

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