032701223-9-18-2024-27-AS-KHOS-D9DHYW-20240923063724

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 032701223
Report Date: 09/06/2024
Date Signed: 09/18/2024 10:11:13 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
06/04/2024 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240604140913

FACILITY NAME:	ARGONAUT CARE HOME, INC.		FACILITY NUMBER:	032701223
ADMINISTRATOR:	NGAIMA, MAMA		FACILITY TYPE:	740
ADDRESS:	860 ARGONAUT DR.		TELEPHONE:	(209) 217-1512
CITY:	JACKSON	STATE: CA	ZIP CODE:	95642
CAPACITY:	6	CENSUS: 5	DATE:	09/06/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Winnifred Delpratt		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff administered unauthorized medication to resident while in care
Staff are not following a resident's licensed physician's orders
Staff are mishandling the residents medications
Staff do not have adequate food service for the residents

INVESTIGATION FINDINGS:

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On 09/05/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to deliver complaint findings for the allegations above. LPA was greeted by Staff Member (SM) Winnifred Delpratt and explained the purpose of the visit. LPA asked that SM Delpratt call the Facility Designated Representative (FDR) to inform them that CCL was present. It was learned that FDR Patrick was out of town and was unable to come to the facility at this time. There was one other staff member present, Opal Hall-Hutchins.
Current census was 5. A brief interview with FDA was conducted.
Allegation: Staff administered unauthorized medication to resident while in care
It was alleged that staff administered unauthorized medication to resident while in care. During the course of this investigation, this LPA reviewed facility documentation and conducted interviews. Based on interviews conducted it was learned that facility staff spoke with R1’s responsible party regarding the residents aggressive behavior. It was learned that staff and R1’s responsible party agreed to obtain additional medication from an outside source. However, once the facility obtained the medication it was relied by R1’s responsible party that they no longer wanted to give this medication to the resident. Facility documentation shows that this medication was not prescribed nor was on medication administration record. Based on the information gathered, it is unclear that staff administered unauthorized medication to resident while in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

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 27-AS-20240604140913

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ARGONAUT CARE HOME, INC.	FACILITY NUMBER: 032701223
	VISIT DATE: 09/06/2024

NARRATIVE

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However, once the facility obtained the medication it was relied by R1’s responsible party that they no longer wanted to give this medication to the resident. Facility documentation shows that this medication was not prescribed nor was on medication administration record. Based on the information gathered, it is unclear that staff administered unauthorized medication to resident while in care.

Allegation: Staff are not following a resident’s licensed physician’s orders

It was alleged that staff are not following a resident’s licensed physicians orders. During the course of this investigation, this LPA reviewed facility documentation and conducted interviews. This LPA conducted 3 staff interviews. 3 out 3 staff members deny that they do not follow the resident’s licensed physician’s orders. It was learned during interviews that the facility administrator consistency informs staff providing information of any changes in medication and ensure that staff understand that new orders. A review of the Medication Administration Record and resident Physician’s orders were conducted where there were no indications to show that the facility did not follow the resident’s licensed physician’s orders. Based on the information gathered, it is unclear if the staff are not following a resident’s licensed physicians orders.

Allegation: Staff are mishandling the residents medications

It was alleged that staff are mishandling the residents medications. During the course of this investigation, this LPA reviewed facility documentation and conducted interviews. This LPA conducted 3 staff interviews. 3 out 3 staff members deny that they mishandle medication. It was learned during interviews that the facility administrator consistency informs staff providing information of any changes in medication and ensure that staff understand that new orders. A review of the Medication Administration Record and resident Physician’s orders were conducted where there were no indications to show that the facility did not follow the resident’s licensed physician’s orders. Based on the information gathered, it is unclear if the staff are not following a resident’s licensed physicians orders

Allegation: Staff do not have adequate food service for the residents

It was alleged that staff do not have adequate food service for the residents. During the course of this investigation, this LPA reviewed facility documentation, conducted interviews and reviewed facility records. Based on interviews conducted 3 out 3 staff members deny that they do not have adequate food service for the residents. Staff report that they go grocery shopping once a week for produce and once a month for bigger items or pantry shopping. It was observed during the LPAs visit that the residents enjoyed the food that they were provided for breakfast and lunch and 3 out 3 residents reported no issues at this time. During these visits, this LPA reviewed the facility food to ensure there was an adequate amount of food supply. This

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20240604140913

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ARGONAUT CARE HOME, INC.	FACILITY NUMBER: 032701223
	VISIT DATE: 09/06/2024

NARRATIVE

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LPA observed a sufficient amount of food supply and snacks during the facility visit. In addition, LPA reviewed facility records which show that the facility is conducting grocery shopping for this facility on a weekly basis. Based on the information gathered it was unclear if the facility did not have an adequate food service for the residents.

Based on information provided through interviews and records reviewed, this allegation is deemed UNSUBSTANTIATED, meaning that there was not a preponderance of evidence to prove or disprove that the allegation occurred as reported.
There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

LIC9099 (FAS) - (06/04)

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