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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700486
Report Date: 09/08/2021
Date Signed: 09/08/2021 06:53:12 PM

Substantiated


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
04/05/2021 and conducted by Evaluator Danyle Wolter
PUBLIC
COMPLAINT CONTROL NUMBER: 25-NP-20210405081042
FACILITY NAME:TUSCANY VILLA CARE HOMEFACILITY NUMBER:
342700486
ADMINISTRATOR:YERBY, ANDREAFACILITY TYPE:
740
ADDRESS:8505 CLOUDCROFT WAYTELEPHONE:
(916) 385-7034
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 4DATE:
09/08/2021
UNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:Shantel Watson, staffTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Facility staff did not follow reporting requirements.
Facility staff did not safeguard resident's personal belongings.
Resident was illegally evicted.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wolter arrived at the facility unannounced on 09/08/2021 to deliver complaint findings for the allegations listed above, LPA met with staff Shantel Watson and explained the purpose of the visit. Prior to initiating visit LPA completed daily self-screening questionnaire to confirm no symptoms of COVID-19, LPA was screened by staff upon entry and wore surgical mask and applied hand sanitizer. LPA contacted administrator via telephone to go over report as they were unable to come to the facility at time of visit, verbal permission was given for staff to sign report.

Throughout the course of the investigation the department reviewed documentation and conducted interviews relevant to the allegations: facility staff did not follow reporting requirements, facility staff did not safeguard residents personal belongings, and resident was illegally evicted. Through interviews it was learned that the facility utilized emergency services for a lift assist for resident (R1) and did not notify the responsible person or the department of this information as no injuries were noted or observed, responsible person was notified

Report continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Danyle Wolter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
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 7
Control Number 25-NP-20210405081042
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: TUSCANY VILLA CARE HOME
FACILITY NUMBER: 342700486
VISIT DATE: 09/08/2021
NARRATIVE
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at a later date. It was also revealed that shortly after the time of the lift assist from the fire department the resident’s hearing aid went missing and was unable to be located. Hearing aid was documented on R1's inventory list upon move in, R1 moved out the beginning of April 2021 and the hearing aid was never located. Documentation reviewed revealed that R1 had a fall on or around 11/24/2020 with no injuries noted which was not reported to the department. R1 experienced a similar incident on 11/13/2020 which was reported to the department on an incomplete incident report. The department received an incident report on 03/25/2021 notifying the department that R1 had been issued an eviction notice however no copy of the notice was received until it was later requested, upon review it was found to be incomplete and therefore not valid.

Due to this information the department finds the allegations to be SUBSTANTIATED, a finding that the complaint is Substantiated means that the allegations are valid because the preponderance of the evidence standard has been met.

The following deficiencies are cited on the attached LIC 9099-D:

§1569.152 Safeguard of resident property; reimbursement for failure to make reasonable efforts; preseumption; penalty

(a) A residential care facility for the elderly, as defined in Section 1569.2, which fails to make reasonable efforts to safeguard resident property shall reimburse a resident for or replace stolen or lost resident property at its then current value. The facility shall be presumed to have made reasonable efforts to safeguard resident property if the facility has shown clear and convincing evidence of its efforts to meet each of the requirements specified in Section 1569.153. The presumption shall be a rebuttable presumption, and the resident or the resident's representative may pursue this matter in any court of competent jurisdiction.

87211 Reporting Requirements

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Danyle Wolter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
LIC9099 (FAS) - (06/04)
Page: 7 of 7
Control Number 25-NP-20210405081042
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: TUSCANY VILLA CARE HOME
FACILITY NUMBER: 342700486
VISIT DATE: 09/08/2021
NARRATIVE
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§1569.683 Eviction notices; reasons for eviction contents; service

(a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction to a resident shall set forth in the notice to quit the reasons relied upon for the eviction, with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. In addition, the notice to quit shall include all of the following:

(1) The effective date of the eviction.

(2) Resources available to assist in identifying alternative housing and care options, including public and private referral services and case management organizations.

(3) Information about the resident's right to file a complaint with the department regarding the eviction, with the name, address, and telephone number of the nearest office of community care licensing and the State Ombudsman.

(4) The following statement: "In order to evict a resident who remains in the facility after the effective date of the eviction, the residential care facility for the elderly must file an unlawful detainer action in superior court and receive a written judgment signed by a judge. If the facility pursues the unlawful detainer action, you must be served with a summons and complaint. You have the right to contest the eviction in writing and through a hearing."

Exit interview conducted, appeal rights provided, and copy of report to be emailed to administrator.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Danyle Wolter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 25-NP-20210405081042
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: TUSCANY VILLA CARE HOME
FACILITY NUMBER: 342700486
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/22/2021
Section Cited
HSC
1569.152(a)
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§1569.152 Safeguard of resident property; [...] (a) A residential care facility for the elderly, as defined in Section 1569.2, which fails to make reasonable efforts to safeguard resident property shall reimburse a resident for or replace stolen or lost resident property at its then current value.
This requirement was not met as evidenced by:
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Licensee to create a plan to replace or reimburse R1 for their lost hearing aid. Copy of plan to be sent to Community Care Licensing by 09/22/2021 by fax.
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interviews and documentation reviewed. The licensee did not comply with the section cited above. R1's hearing aid was lost in March 2021 and was not found, This poses a potential health, safety, and/or personal rights risk to residents in care.
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Deficiency Dismissed
Type B
09/22/2021
Section Cited
CCR
87211(a)(1)(D)
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87211 Reporting Requirements
(a) Each licensee shall furnish to the licensing agency such reports as the Department [...]: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident [...] (D) Any incident which threatens the welfare, safety or health of any resident [...]
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Licensee to review section 87211 Reporting Requirements and send a letter of understanding to Community Care Licensing by 09/22/2021 by fax. Additionally, licensee to ensure incident reports are completely filled out, including second page "action taken" and "licensee comments" sections.
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This requirement was not met as evidenced by: interviews and documentation reviewed. The licensee did not comply with the section cited above by not reporting incidents which threatened the welfare of R1. This poses a potential health, safety, and/or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Danyle Wolter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 25-NP-20210405081042
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: TUSCANY VILLA CARE HOME
FACILITY NUMBER: 342700486
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/22/2021
Section Cited
HSC
1569.683(a)
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§1569.683 Eviction notices; reasons for eviction contents; service (a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction to a resident shall set forth in the notice to quit the reasons relied upon for the eviction, [...]
This requirement was not met as evidenced by:
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Licensee to review eviction notices requirements and send letter of understanding to Community Care Licensing by 09/22/2021 by fax.
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interviews and documentation reviewed. The licensee did not comply with the section cited above. R1 was issued an incomplete eviction notice. This poses a potential health, safety, and/or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Danyle Wolter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
04/05/2021 and conducted by Evaluator Danyle Wolter
PUBLIC
COMPLAINT CONTROL NUMBER: 25-NP-20210405081042

FACILITY NAME:TUSCANY VILLA CARE HOMEFACILITY NUMBER:
342700486
ADMINISTRATOR:YERBY, ANDREAFACILITY TYPE:
740
ADDRESS:8505 CLOUDCROFT WAYTELEPHONE:
(916) 385-7034
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: DATE:
09/08/2021
UNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:TIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Facility staff did not follow resident's doctor's orders.
Facility staff did not inclusively account for resident's belongings at time of admission.
Facility staff did not correctly manage resident's medications.
Facility did not have sufficient staff to meet residents' needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wolter arrived at the facility unannounced on 09/08/2021 to deliver complaint findings for the allegations listed above, LPA met with staff Chantel Watson and explained the purpose of the visit. Prior to initiating visit LPA completed daily self-screening questionnaire to confirm no symptoms of COVID-19, LPA was screened by staff upon entry. LPA contacted administrator via telephone to go over report as they were unable to meet LPA at the facility at time of visit.

Throughout the course of the investigation the department reviewed documentation and conducted interviews relevant to the allegations: facility staff did not follow resident's doctor's orders, facility staff did not inclusively account for each resident's belongings at time of admission, facility staff did not correctly manage resident's medications, and faciliy did not have sufficient staff to meet residents' needs. Documentation reviewed revealed doctor's orders for how R1's hearing aids were to be managed during naps and at night, interviews conducted revealed that facility followed them to the best of their capabilities but R1 was not always compliant.

Report continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Danyle Wolter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 25-NP-20210405081042
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: TUSCANY VILLA CARE HOME
FACILITY NUMBER: 342700486
VISIT DATE: 09/08/2021
NARRATIVE
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Documentation reviewed showed that an inventory list was completed and signed by R1's responsible person shortly after admission, however interviewed conducted allege that it was not always updated as new items were purchased. Centrally stored medication log reviewed showed that R1 started a new medication shortly after arriving at the facility, the medication was logged and the medication was centrally stored and dispensed as ordered according to interview with facility administrator. Text message correspondences reviewed reveal that there was a possible shortage of the medication however the cause is unknown. According to facility administrator there was not a shortage, the medication was refilled timely by the pharmacy, and R1 never missed a dose. No documentation reviewed revealed that the resident's needs were not met, however interviews regarding staff being able to meet resident's needs resulted in conflicting information.

Due to this information the department finds the allegations to be UNSUBSTANTIATED a finding of unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and copy of report emailed to administrator.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Danyle Wolter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 7