525002755-8-4-2021-25-AS-RLBN-C72W34-20210920165517

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525002755
Report Date: 08/04/2021
Date Signed: 08/04/2021 11:44:46 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 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
06/03/2021 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 25-AS-20210603155243

FACILITY NAME:	LASSEN HOUSE SENIOR LIVING		FACILITY NUMBER:	525002755
ADMINISTRATOR:	MATLOCK, ESMERALDA		FACILITY TYPE:	740
ADDRESS:	705 LUTHER RD		TELEPHONE:	(530) 529-2900
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY:	86	CENSUS: 59	DATE:	08/04/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Sue Todd, Executuve Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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#1 Neglect/Lack of Care and Supervision: The lack of care and supervision by facility staff resulted in resident sustaining multiple falls with injuries.

#2 Resident 's personal rights to staff that are sufficient in numbers, qualifications, and competency to meet their needs were denied.

INVESTIGATION FINDINGS:

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08/04/2021 10:45 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility to deliver the results of an investigation that was conducted by Department of Social Services Community Care Licensing Investigations Branch for a complaint that was received on June 3, 2021.

Before entering the facility LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask, gloves. Additionally, LPA Knight was screened by facility staff. LPA met with Administrator Sue Todd. LPA Knight explained the reason for the visit.

Continued on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

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 4

Control Number 25-AS-20210603155243

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: LASSEN HOUSE SENIOR LIVING	FACILITY NUMBER: 525002755
	VISIT DATE: 08/04/2021

NARRATIVE

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Allegation 1: Neglect/Lack of Care and Supervision: The lack of care and supervision by facility staff resulted in resident sustaining multiple falls with injuries.

Findings: Substantiated

Resident 1’s (R1) Needs and Services plan as of 5/25/2021, indicated R1 is a high fall risk due to weakness, mentation, and medications. R1 requires frequent checks and anticipation of needs. Event Reports regarding R1 for the months of 3/1/2021 to 6/11/2021 were obtained by Lassen House Senior Living. There were 13 Event Reports obtained and 12 of the 13 Event Reports were about R1 having a fall. A witness reported R1 has fallen multiple times. R1 has multiple skin tears and bruises on themselves that the witness could not tell which tears were new or old. A review of SECH medical records indicated R1 was transported to the hospital eight times due to unwitnessed falls within three months. On 3/26/2021, SECH medical records indicated R1 had a small hairline fracture on their left seventh rib. SECH medical records stated R1 had multiple skin tears and bruising. Staff reported the facility is understaffed. Staff stated if the facility was fully staffed, the majority of the falls would have not happened. Staff stated residents are checked every hour, but if a resident is considered a fall risk, they are checked every 30 to 40 minutes. Staff estimated R1 had about 15 falls within the last six months. Staff stated residents are checked every two hours. Based on the investigator’s review of R1’s Care History regarding the two hours checks, it is unclear if R1 was checked on every two hours. For an example, there are three entries for the same date and time.

Continued on LIC9099-C

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 25-AS-20210603155243

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: LASSEN HOUSE SENIOR LIVING	FACILITY NUMBER: 525002755
	VISIT DATE: 08/04/2021

NARRATIVE

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ALLEGATION 2: Resident 's personal rights to staff that are sufficient in numbers, qualifications, and competency to meet their needs were denied.

Staff reported the facility is understaffed. Staff stated if the facility was fully staffed, the majority of the falls would have not happened. Staff stated residents are checked every hour, but if a resident is considered a fall risk, they are checked every 30 to 40 minutes. Staff estimated R1 had about 15 falls within the last six months. Staff stated residents are checked every two hours. Based on the investigator’s review of R1’s Care History regarding the two hours checks, it is unclear if R1 was checked on every two hours. For an example, there are three entries for the same date and time.

Based on the interviews and evidence obtained by Department of Social Services Community Care Licensing Investigations Branch, the preponderance of evidence standard has been met, therefore, the above allegations are found to be substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D. Appeal rights were provided, and an exit interview conducted.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 25-AS-20210603155243

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: LASSEN HOUSE SENIOR LIVING	FACILITY NUMBER: 525002755
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/04/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/04/2021 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411(a) Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The licensee to provide a new staffing schedule that will include an increase in staff during the evening and NOC shifts to ensure the safety of the residents in care.
	8 9 10 11 12 13 14	Based on the Investigator’s interviews of staff it was determined that there was not enough staff on duty to provide the required level of care and supervision necessary to meet resident’s needs, resulting in the resident experiencing multiple falls which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	This schedule shall be completed within two weeks. Proof of completion shall be sent to the licensing agency by 8/18/2021.
Type A 08/04/2021 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	87468.2 (a)(4) Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights. (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs: This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The licensee to provide a plan for recruiting, hiring and training of new staff.
	8 9 10 11 12 13 14	Based on the Investigator’s interviews of staff it was determined that the facility has not consistently had enough staff to care for residents which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	This plan shall be completed within 2 weeks. Proof of completion shall be sent to the licensing agency by 8/18/2021.

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: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021

LIC9099 (FAS) - (06/04)

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