525002755-1-3-2023-25-AS-KHOS-CMYT4Q-20230111132420

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525002755
Report Date: 01/03/2023
Date Signed: 01/03/2023 11:19:59 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
10/28/2022 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 25-AS-20221028161057

FACILITY NAME:	LASSEN HOUSE SENIOR LIVING		FACILITY NUMBER:	525002755
ADMINISTRATOR:	TODD, SUSAN		FACILITY TYPE:	740
ADDRESS:	705 LUTHER RD		TELEPHONE:	(530) 529-2900
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY:	86	CENSUS:	DATE:	01/03/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Sue Todd - administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility is not following hospice plan of care - UNSUBSTANTIATED
Neglect - UNSUBSTANTIATED
Personal rights - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

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01/23/2022 10:30 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with administrator Sue Todd. The purpose of this visit was to deliver the results of the complaint investigation of the above allegations. Prior to initiating the visit, LPA completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Mask, gloves. In addition, LPA was screened by facility staff.
During the course of the investigation the administrator and 3 staff were interviewed. LPA obtained the following documents to investigate the above allegations: Physician’s Report (LIC602), Admissions agreement, Pre-Appraisal Needs and Services Plan, medical records, staff list with phone numbers, resident list.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023

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 3

Control Number 25-AS-20221028161057

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: LASSEN HOUSE SENIOR LIVING	FACILITY NUMBER: 525002755
	VISIT DATE: 01/03/2023

NARRATIVE

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Facility is not following hospice plan of care – UNSUBSTANTIATED

It was alleged that the facility is not following a resident’s hospice plan of care.

LPA reviewed Resident 1’s (R1) Hospice IDG Comprehensive Assessment and Plan of Care Update report dated 09/15/2022 and discovered that the plan stated, “ Facility needs education regarding charting of eating/elimination, med reconciliation, and follow up with hospice when change in status…i.e. bowels.” This hospice care plan does not mention a requirement for facility staff to document resident bowel movements.

LPA reviewed Resident 1’s (R1) Hospice IDG Comprehensive Assessment and Plan of Care Update report dated 11/28/2022 and discovered that the plan stated “Nutrition/elimination: Intakes fluctuate, constipation issues- using Senna, MiraLAX. Nursing Plan for next 14 days: Monitor constipation- effectiveness of current bowel regimen.” This hospice care plan did not mention anything about facility staff documenting bowel movements.

3 of 3 staff who were interviewed revealed that staff are currently documenting resident bowel movements. 3 of 3 staff stated they call hospice if a hospice resident has not had a bowel movement in three days. 3 of three staff stated they dispense oral medications for bowel care if ordered by hospice but if a resident requires a suppository, they notify the hospice nurse.

The administrator stated that staff documentation of resident bowel movements was not being done consistently. Administrator stated “I reviewed the hospice care plan and there isn't anything in there that directs the caregivers to document bowel movements. It says more education/teaching is needed with the staff on documentation for bowel movements.” The administrator stated They don’t currently, that is why I want to put that documentation on the MAR. Hospice asked us to verbally notify them if R1 had not had a bowel movement on the fourth day and to give R1 MiraLAX on day 4.

It was determined that at the time the complaint was filed staff were not consistently documenting R1’s bowel movements. Once this was brought to the attention of the administrator, the administrator started requiring staff to document bowel movements in the MAR to ensure consistency in documentation. However, the hospice care plan does not include the requirement for staff to document R1’s bowel movements. Interviews confirmed that staff do call hospice if a resident has not had a bowel movement in 3 days and staff are dispensing medications that are within the scope of their duties. This allegation is unsubstantiated.

Continued on LIC9099-C

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20221028161057

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: LASSEN HOUSE SENIOR LIVING	FACILITY NUMBER: 525002755
	VISIT DATE: 01/03/2023

NARRATIVE

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Neglect - UNSUBSTANTIATED

This allegation is too vague and broad in scope to investigate without more specific details. There was not enough information provided by the complainant. Complainant did not return LPA’s telephone call. This allegation is unsubstantiated.

Personal rights - UNSUBSTANTIATED

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was provided to facility administrator Sue Todd

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023

LIC9099 (FAS) - (06/04)

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