525002755-11-21-2022-25-AS-TORZ-CLWPJF-20221208102129

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525002755
Report Date: 11/21/2022
Date Signed: 11/21/2022 10:58:22 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
07/13/2022 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 25-AS-20220713084853

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:	11/21/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Sue Todd - administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility staff did not properly care for resident's pressure sore
Facility staff do not properly assist residents with oxygen
Facility staff do not properly conduct transfer assistance for residents
Facility staff do not meet the care needs of the residents

INVESTIGATION FINDINGS:

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11/21/2022 10:00 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 administrator and 5 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: 11/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022

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-20220713084853

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: 11/21/2022

NARRATIVE

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Facility staff did not properly care for resident's pressure sore - UNSUBSTANTIATED

LPA requested and received medical records from the local hospital that provides care for R1. There was no mention of R1 having pressure injuries in the responsive records. LPA did receive a “Quick Notes” document that was written by R1’s physician dated 6/29/2022 which states that R1 no longer had a wound on the end of the left great toe, the skin is Intact, no new wounds were seen, wound healed.

5 of 5 staff stated they had been trained on how to care for pressure injuries.

Administrator stated in regard to the spot on R1's toe the home health nurse said there was nothing she needed to do with it. The facility coordinated with the home health nurse who suggested that it should be monitored, the family was OK with this decision.

It was determined that R1 did have a abcess on their toe and per R1’s physician the wound had healed. Staff have been trained on how to properly care for pressure injuries should a resident have a pressure injury. This allegation is unsubstantiated.

Facility staff do not properly assist residents with oxygen - UNSUBSTANTIATED

It was alleged that facility staff do not properly assist residents with oxygen.

R1’s Care Plan notes that R1 needs assistance overseeing R1’s care with oxygen. Resident is on oxygen at 2 liters continuously. Resident is independent in changing from their room concentrator to O2 tanks as needed. Staff will assist with filling humidifier bottle and change of tubing monthly. Ensure resident is using their portable oxygen tank for all meals. Resident is to dial the valve to CF2 and 0 when they are hooked up to their portable tank. Resident is now on continuous oxygen at 2L min via nasal cannula. Resident is to utilize the portable oxygen tank anytime they are outside of their room.

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: 11/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20220713084853

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: 11/21/2022

NARRATIVE

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Staff interviews revealed that staff have been trained to ensure the resident is wearing the nasal cannula correctly, check the output and make sure the oxygen tank is not running out.

Administrator stated R1's portable oxygen tanks were running out quickly. R1 takes a long time to eat their meals and one oxygen tank would not last through an entire mealtime. R1 started to eat in their room. R1 takes their oxygen off frequently. R1 should not go out for meals anymore, but the family made a decision that they were OK to go out and eat and to doctors’ appointments without R1's oxygen.

It was determined that even though R1’s Care Plan directs that R1 should utilize their portable oxygen tank anytime they are outside of their room R1 chooses to take their oxygen off frequently, staff cannot make R1 wear their oxygen. Facility also cannot force R1’s family to ensure that R1 uses their oxygen when they take R1 out of the facility. This allegation is unsubstantiated.

Facility staff do not properly conduct transfer assistance for residents - UNSUBSTANTIATED

It was alleged that facility staff do not properly conduct transfer assistance for residents.

5 of 5 staff stated they had been trained on how to properly assist in transferring residents. The training was conducted by the Director of Health & Wellness, visiting physical therapists and facility Med Techs. This allegation is unsubstantiated.

Facility staff do not meet the care needs of the residents - UNSUBSTANTIATED

It was alleged that facility staff do not meet the care needs of the residents.

There was not enough information provided by the complainant. LPA was unable to make further contact with the complainant due to unreliable contact information provided in the complaint, and the allegation is too vague. This allegation is 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: 11/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022

LIC9099 (FAS) - (06/04)

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