525002755-2-15-2024-59-AS-KHOS-D32M53-20240304081741

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525002755
Report Date: 02/15/2024
Date Signed: 02/15/2024 02:19:24 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/24/2024 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20240124093740

FACILITY NAME:	LASSEN HOUSE SENIOR LIVING		FACILITY NUMBER:	525002755
ADMINISTRATOR:	BRASWELL, NICOLE		FACILITY TYPE:	740
ADDRESS:	705 LUTHER RD		TELEPHONE:	(530) 529-2900
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY:	86	CENSUS: 63	DATE:	02/15/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Nicole Braswell -administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility staff are not ensuring that an appropriately skilled professional is assisting the resident with injections. - UNFOUNDED

INVESTIGATION FINDINGS:

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02/15/2024 1:00 PM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with administrator Nicole Braswell. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA interviewed the administrator and requested the following documents: staff list with telephone numbers, Physicians Report, care plan, physician’s order for medication for 1 resident.

Continued on LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

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 59-AS-20240124093740

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LASSEN HOUSE SENIOR LIVING	FACILITY NUMBER: 525002755
	VISIT DATE: 02/15/2024

NARRATIVE

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Facility staff are not ensuring that an appropriately skilled professional is assisting the resident with injections. - UNFOUNDED

LPA reviewed a physician’s order dated 10/23/2024 ordering injections to be administered once every two weeks for Resident 1 (R1).

During the course of the investigation, it was learned that a home health agency was contracted to administer an injection to R1 twice a month starting in October 2023. The home health agency inadvertently discharged the resident from services on 01/09/2024 and discontinued the injections without informing the family or the facility. The facility did not manage this medication for the resident as the facility is not allowed to administer injections. LPA was informed by complainant that the complaint should have been made against the home health agency, not the facility. This allegation is unfounded.

This agency has investigated the complaint alleging the facility failed to ensure that an appropriately skilled professional was assisting a resident with injections. As a result of the investigation the agency has found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted. A copy of the report was provided to administrator Nicole Braswell.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC9099 (FAS) - (06/04)

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