342700613-6-10-2021-27-AS-MSEY-C3VSXS-20210611141626

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700613
Report Date: 06/10/2021
Date Signed: 06/10/2021 01:31:21 PM

Unsubstantiated

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
03/18/2021 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 27-AS-20210318090933

FACILITY NAME:	CASTLE OASIS HOME CARE LLC		FACILITY NUMBER:	342700613
ADMINISTRATOR:	NICHOLS, GARY		FACILITY TYPE:	740
ADDRESS:	5205 CASTLE ST		TELEPHONE:	(916) 865-7726
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	6	CENSUS: 6	DATE:	06/10/2021
		UNANNOUNCED	TIME BEGAN:	01:21 PM
MET WITH:	Gary Nichols, Administrator		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident overdosed on medications leading to death

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Administrator, Gary Nichols, to deliver findings in the allegation of resident overdosed on medications leading to death. Facility currently does not have any COVID-19 positive cases. LPA wore N95 mask and was screened by facility upon entry. Facility staff wore masks in the care home.

During the course of the investigation, LPA conducted interviews and obtained documentation pertinent to the investigation. According to medical records received from Sutter Roseville Medical Center, resident (R1) was hospitalized on 2/19/21 for left hip pain after a recent fall in their home and for a left intertrochanteric femur fracture. On 2/20/21, R1 had surgery on their fractured hip and was found to have a COVID-19 infection on 2/25/21. R1 was isolated for 10-days due to the COVID-19 infection. On 3/5/21, family of R1 requested that resident receive assistance from Suncrest Hospice upon discharge from the hospital. R1 was discharged from Sutter Roseville Medical Center on 3/7/21 to the care home. R1's discharge diagnosis was acute left
**********************************************Continued on LIC9099-C************************************************

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

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 2

Control Number 27-AS-20210318090933

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: CASTLE OASIS HOME CARE LLC	FACILITY NUMBER: 342700613
	VISIT DATE: 06/10/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

intertrochanteric femur fracture, acute kidney injury on CKD stage 3, acute blood loss anemia on chronic normocytic anemia, and failure to thrive.

According to Suncrest Hospice records, the primary diagnosis was protein calorie malnourishment and a Hospice Physician stated that R1 had a terminal illness with a life expectancy of six months or less if illness follows its usual course. On 3/8/21, Hospice Physician indicated that R1 has declined precipitously since a complicated heart surgery, broken femur and other injuries. On 3/12/21, R1 began transitioning, had no intake for 5-days, and was non-responsive to verbal or tactile stimuli. According to interviews with Hospice staff and Hospice records, Hospice nurse began providing 0.5 ml of Morphine to regulate R1's breathing, as R1 began having rapid shallow breathing.

According to interviews with Hospice staff, the Hospice Aids would provide assistance with daily living (ADL's), which includes bathing/bed baths, incontinent care, nail care, dressing, linen change, denture care, skin care, foot care, documenting bowel movements, and repositioning patient. Also, according to interviews with Hospice staff, the Hospice Nurse typically provides care, which includes administering medications, once or twice per week, however, due to R1's rapid decline, the Nurse provided care once or twice daily. Interviews indicated that the Hospice Nurse provided R1 with medications.

On 3/15/21, Suncrest Hospice was notified that R1 had stopped breathing at 0637 hours. Hospice Nurse arrived at the care home and pronounced R1 deceased at 0732 hours. Medication disposal was conducted by the Administrator and Hospice Nurse on 3/15/21.

Sacramento County Death Certificate issued on 4/5/21, indicates R1's date of death as 3/15/21 and cause is Acute Diastolic Congestive Heart Failure. The Death Certificate did not indicate a cause of death pertaining to medications.

Based on documentation reviewed and interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies are being cited during this visit.

Exit interview conducted.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2