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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700801
Report Date: 02/21/2025
Date Signed: 02/21/2025 06:01:18 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
11/25/2024 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20241125080359
FACILITY NAME:MINNESOTA HOME CAREFACILITY NUMBER:
342700801
ADMINISTRATOR:OKYERE, VERA A.FACILITY TYPE:
740
ADDRESS:7448 MINNESOTA DR.TELEPHONE:
(916) 729-9461
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 4DATE:
02/21/2025
UNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Vera Okyere, Administrator TIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff do not provide a sufficient quality of food to resident.
Staff do not ensure that resident's incontinence needs are being met.
Staff do not ensure that resident's showering needs are being met.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint received on November 25, 2024. LPA initially met with staff, Bright Asante, and then shortly met with Administrator, Vera Okyere, and stated the reason for today's inspection. LPA observed (3) residents eating dinner in the common area and (1) resident in resting in her room.

During the investigation, LPA interviewed the Administrator, (1) care staff, resident (R1), (3) additional residents, and (2) family members of (R1). The Ombudsman also spoke to (R1) and LPA about the allegations and asked (R1) to take photos of food being served. LPA reviewed documentation related to (R1), including,but not limited to, physician's report, pre-appraisal, and care plan. The physician’s report, dated 11/7/24, states (R1) has a diagnosis of Orthopedic aftercare following surgery, needs assistance with bathing, dressing and toileting, has left side weakness,a history of skin breakdown, is not incontinent, and requires a special diabetic diet that is easy to chew and has no added salt. The physician's report does not note any cognitive functioning deficits for (R1). The results of the investigation are as follows:
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
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 9
Control Number 59-AS-20241125080359
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MINNESOTA HOME CARE
FACILITY NUMBER: 342700801
VISIT DATE: 02/21/2025
NARRATIVE
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9099C-1.. Allegation: Staff do not provide a sufficient quality of food to resident. The allegation states (R1) is diabetic, and the facility is not feeding her well. On 11/21/24, (R1) was served a hot dog bun with peanut butter for dinner and on 11/22/24, (R1) was given 2 pieces of bread with cheese sauce for dinner.

On 11/26/24, (R1) confirmed that she was served a hot dog bun with peanut butter and then top ramen because she is "always hungry" because they do not give her "enough" food. (R1) stated they sometimes offer her mixed canned veggies, applies, bananas, and raw carrot and broccoli, but a fruit and vegetable are not offered at every meal.

The Administrator asserted (R1) "always tells us what she want to eat" and not follow the menu, explaining that for lunch today, staff prepared a grilled cheese sandwich and an apple but (R1) has been requesting "hamburgers, mashed potatoes with gravy, and BBQ chicken". The Administrator added that for Thanksgiving, she has placed an order with a local grocery store for their Thanksgiving meal.

A family member stated on 12/20/24 that (R1) called 9-1-1 last week because her blood sugar was low and the facility is not serving good food and that another family member of (R1) brings food to the facility. This family member stated the food served is not good and staff are serving a hot dog bun with nacho sauce inside. (R1) stated staff will take an hour to get her cottage cheese and yogurt that her daughter brought to the care home for her.

LPA was provided with photos of (4) meal plates served to (R1) during her stay at the facility. One plate showed a bologna sandwich only; a second plate showed pasta noodles with sauce only; a third plate showed a peanut butter sandwich and two cut orange pieces; a fourth photo showed cold cereal and milk with a few banana pieces.

On 1/22/25, LPA observed resident (R2) to be eating a chicken bake with fruit and a drink; (R3) was eating pureed food since returning from the hospital recently, and (R4) was eating a chicken bake. On that day, LPA observed more frozen food than fresh food and frozen food consisted of packages of hot dogs, corn dogs and meatballs. There were about a dozen eggs, some grapes, other produce items in the refrigerator. LPA observed an extra refrigerator in the pantry area to contain hot dog/hamburger buns, milk and lots of pantry items, including pasta, Pop-Tarts, canned food, Cream of Wheat, and Oatmeal.



*cont on 9099C-2..
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC9099 (FAS) - (06/04)
Page: 9 of 9
Control Number 59-AS-20241125080359
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MINNESOTA HOME CARE
FACILITY NUMBER: 342700801
VISIT DATE: 02/21/2025
NARRATIVE
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9099C-2.. Under "Basic Services, the Admission Agreement notes that (R1) will receive: 1- Three nutritious meals daily and snacks and 2- Special diets if prescribed by a doctor. (R1's) physician's report also notes that (R1) requires a special, diabetic diet, low in salt that is "easy to chew".

Per Mayo Clinic, a diabetic diet should consist of: Balance carbs with fiber and protein in each meal. This is easy if you use the plate method. Make half of your plate vegetables, a quarter of your plate a carb like brown rice, black beans, or whole-wheat pasta, and the other quarter of your plate a healthy protein like chicken breast, fish, lean meat, or tofu.

Administrator stated (R1) refused vegetables as they were "too crunchy" and refused all soups and all breakfast except for Cream of Wheat or Oatmeal. The Administrator stated she called 9-1-1 the time it was low, and emergency staff determined that (R1's) arm sensor to measure blood sugar needed to be replaced. The emergency staff tested (R1's) blood sugar using their own test and it was low but not as low as the sensor indicated. (R1) did not have to be sent out.

A family member of (R1) stated there were no snacks served so she brought snacks, such as soup, and (S1) refused to serve them to (R1). A second family member stated that after (R1) had low blood sugar, the family brought over candy covered peanuts, and staff placed them on the other side of (R1's) room so she couldn't reach them. The Administrator stated (R1's) blood sugar was never high and was normal on all days but that one day when the sensor needed replacing. (R1) would regularly talk to her doctor.

Based on information obtained during the investigation, the Department find the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Allegation: Staff do not ensure that resident's incontinence needs are being met. The allegation states (R1) asked for their adult diaper to be changed, and the caregiver will only change (R1) (3) times per day and (R1) is sitting in their urine all day.

The Administrator stated on 11/26/24 she told (R1’s) daughter that the facility "doesn't buy briefs" and the family has not brought any briefs over at all since resident moved in on 11/8/24. The Administrator stated staff will change (R1) when the call light is pressed and that (R1) "will push the button frequently, about every hour". The Administrator asserted that (R1) "told staff they have to manage the diapers and can't change her too often", and “the first two weeks when the facility was buying the diapers, (R1) would call every 45 minutes to be changed". *cont on 9099C-3..
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 9
Control Number 59-AS-20241125080359
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MINNESOTA HOME CARE
FACILITY NUMBER: 342700801
VISIT DATE: 02/21/2025
NARRATIVE
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9099C-3.. On 11/26/24, (R1) stated to LPA that she is changed "usually two times per day" and staff "cannot reposition" her, as staff (S1), stated her back hurts and the Administrator or another staff (S3) are needed to assist. On 11/26/24 (3:20 pm) (R1) stated to LPA that staff have changed her diaper twice today, once after breakfast and then again after lunch, and she needs to be changed again now, and "staff will go 4-5 hours sometimes to check me and they only change me at mealtimes".

(R1) stated she is "not sure" if NOC staff are awake or on-call and was also "not sure" if the call buttons are working, asserting she pushed her button three times recently and staff, (S1) took 30 minutes to respond, explaining she "was busy with other clients". LPA observed an unopened package of diapers in (R1's) room on 11/26/24.

A family member of (R1) stated she was told at move in that the family provides incontinent products and she ensured that there were always diapers available to (R1). She stated she would bring over (2) large packages, every two weeks, and (R1) never ran out. The family member stated that she also later brought over wipes after learned wipes were not being used and (S1), who provided all the care, was still not using them. The Administrator stated that the facility provides wipes and all staff use them. The family member stated that at least (1) night (R1) was sitting in a soiled diaper.

Based on information obtained during the investigation, the Department find the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Allegation: Staff do not ensure that resident's showering needs are being met. The allegation states (R1) has not been bathed for about a week and when (R1) asked for a bath, the caregiver refused to give them one.

On 11/26/24, the Administrator explained that she "has been calling home health every other day" to arrange for Physical Therapy to come out but has not heard from Home Health since (R1) moved in, on 11/8/24. The Administrator stated that "two to three times per day, (R1) goes BM all over her bed and we have to clean the sheets", and "every other day, (R1) receives a bed bath". The Administrator agreed to go to speak to the home health social worker the next day, and advised LPA that she had been informed home health was discontinued due to resident’s insurance coverage. *cont on 9099C-4..
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 9
Control Number 59-AS-20241125080359
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MINNESOTA HOME CARE
FACILITY NUMBER: 342700801
VISIT DATE: 02/21/2025
NARRATIVE
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9099C-4... On 11/26/24, (R1) stated she received her "first bath yesterday", which was "brief". A family member stated that (R1) received (2) bed baths during the time she resided at the facility and (S1) gave her the first one and the Administrator gave her the second one, on/around 12/31/24. This family member stated that (S1) "grabbed a cold wash cloth and gave (R1) a quick wipe down".

The family member stated that (S1) would not strap (R1's) correctly which may have caused (R1's) bedding to become soiled and need changing frequently.

The family member stated that the facility "had all the equipment " to provide the ADL's but didn't and the family was not aware the care was not being done, until about (2) weeks after (R1) moved in and the family was informed they couldn't move (R1).

The Administrator informed LPA that (S1) was let go as a employee on/around January 2025.

Based on information obtained during the investigation, the Department find the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.


Per California Code of Regulations,Title 22, Division 6, Chapter 8, the following (3) deficiencies are being cited on the 9099-D pages.

Exit interview. Copy of report and appeal rights provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 9
Control Number 59-AS-20241125080359
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MINNESOTA HOME CARE
FACILITY NUMBER: 342700801
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/07/2025
Section Cited
CCR
87555(a)
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87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.
This requirement is not met as evidenced by:
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Licensee/Administrator agree to watch an audio training on nutritious diet, including for diabetes, and submit a menu and snack schedule by 3/7/25.

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Based on interviews conducted and photo documentation, the Licensee did not ensure that (R1) was provided with meals and snacks, as stated in the Admission Agreement and per resident's special diet requirement, per the physician's report, which posed a potential health and safety risk to residents in care.
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Request Denied
Type B
03/07/2025
Section Cited
CCR
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87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:
(2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night.
This requirement is not met as evidenced by:
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Licensee/Administrator agree to conduct staff training on how/when to document when incontinent care is provided.

Submit proof of training and form to be used by 3/7/25.
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Based on interviews conducted, the LIcensee did not ensure that (R1) was provided with regular incontinent care during the awake hours and during the night on at least (1) occasion after (R1) had lose stool, which posed a potential health and safety risk to residents in care.
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Administrator to submit additional documentation of incontinent changes provided.
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: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 9
Control Number 59-AS-20241125080359
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MINNESOTA HOME CARE
FACILITY NUMBER: 342700801
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/07/2025
Section Cited
CCR
87464(d)
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87464 Basic Services - (d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. This requirement is not met as evidenced by:
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LIcensee/Administrator agree to start documenting when a shower is given or refused- signed by staff and the resident.

Training to be conducted with all staff and Admin to submit documentation of how the showers will be documented by 3/7/25.
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Based on interviews conducted, the Licensee did not ensure that (R1) received regular bathing, at least twice weekly, and when needed, which posed a health and safety 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: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
11/25/2024 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20241125080359

FACILITY NAME:MINNESOTA HOME CAREFACILITY NUMBER:
342700801
ADMINISTRATOR:OKYERE, VERA A.FACILITY TYPE:
740
ADDRESS:7448 MINNESOTA DR.TELEPHONE:
(916) 729-9461
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: DATE:
02/21/2025
UNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Vera Okyere, Administrator TIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Facility staff do not allow resident to turn their light on.
Staff do not ensure that resident is receiving their medication as prescribed.
INVESTIGATION FINDINGS:
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LPA reviewed documentation related to (R1) including medication orders and the Centrally Stored Medication List (LIC622). LPA also interviewed the Administrator, resident (R1), and (2) family members.
The results are as follows:

Allegation: Facility staff do not allow resident to turn their light on.
The allegation states (R1) is laying in the dark all day, and they will not keep a light on for (R1), even when (R1) has asked for the light to be put on.

The Administrator stated that (R1) "Initially moved into room #x, directly across from room #y, and staff never said (R1) can't have the lights on, adding that resident, (R4), turns the lights on and off, all the time, throughout the facility.

On 11/26/24, (R1) stated she initially had the room across the hall and the light was "always turned off in the room", but when her hospital bed was delivered, she was moved to the room she is in now, and they turn off the lights at 6:00 pm."
*cont on 9099AC-1..
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 9
Control Number 59-AS-20241125080359
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MINNESOTA HOME CARE
FACILITY NUMBER: 342700801
VISIT DATE: 02/21/2025
NARRATIVE
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9099A-C-1.. (R2) responded that staff " let me turn them on during the day but I like to sleep with the light off at night". The Administrator stated a resident can leave the lights and television in their room all day and all night and (R1) would keep the television on all night.

LPA observed night-lights in the common areas

Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- a finding that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred.



Allegation: Staff do not ensure that resident is receiving their medication as prescribed. Allegation states (R1) is prescribed an antidepressant medication, Wellbutrin, and staff haven’t administered the medication since (R1) moved in.

On 11/26/24, the Administrator stated (R1) moved in with 14 days of medications, but there were "4-5 missing medications", based on the medication list (R1) moved in with, and she let (R1’s) daughter know, a week ago. The Administrator stated she "doesn't know” the medication, Wellbutrin, and the "daughter is handling all the medications".

On 11/26/24, (R1) stated she ran out of the antidepressant, Wellbutrin, commenting she thinks the prescription had run out and explained the request for a refill was "just sent in" but she is not sure if it was approved. LPA observed that (11) medications were logged as started on 11/8/24, including at least one medication for diabetes.

(R1's) family member stated that (R1) may have not had this medication at the beginning but eventually got the medication filled, confirming she would pick up and deliver all medications to the facility for (R1).

Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- a finding that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred.



Exit interview. Copy of report provided to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 9