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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701286
Report Date: 05/29/2024
Date Signed: 05/29/2024 04:33:25 PM

Substantiated


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
05/28/2024 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240528100935
FACILITY NAME:BEATRICE HOME CAREFACILITY NUMBER:
342701286
ADMINISTRATOR:CLARK, BEATRICEFACILITY TYPE:
740
ADDRESS:1014 FERNANDO WYTELEPHONE:
(916) 270-3961
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY:6CENSUS: 5DATE:
05/29/2024
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Beatrice ClarkTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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 Facility staff do not ensure residents have bedsheets
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct a 10-Day Complaint Investigation. LPA Valerio met with facility staff Etta Mae, and explained the purpose of the visit. LPA Valerio was later met by Administrator Beatrice Clark

LPA Valerio requested the following documentation: LIC 500 Personnel Report, LIC 9020 Register of Facility Clients/Residents, Staff Schedule for May 2024, Staff files for Staff 1 (S1) - Staff 2 (S2), Resident File for Resident 1 (R1), Resident 2 (R2), Resident 3 (R3), Resident 4 (R4), and Resident 5 (R5). Staff Files to include copy of identification, copy of application, and description of duties. Resident File to include admission agreement, LIC 602 Physician's Report, and Appraisal/Needs and Services Plan

LPA Valerio observed the facility. Upon arrival, facility staff was observed by LPA Valerio to be sweeping the front outside area of the home.
Continues on LIC 9099 - C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
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 4
Control Number 27-AS-20240528100935
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: BEATRICE HOME CARE
FACILITY NUMBER: 342701286
VISIT DATE: 05/29/2024
NARRATIVE
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Continued from LIC 9099

There were 3 residents sitting in the kitchen area enjoying coffee. There was another staff that exited the facility once LPA Valerio arrived. According to an interview with facility staff and administrator, the person was a housekeeper and not a caregiver. LPA observed 5 bedrooms. LPA observed 3 out of 5 bedrooms to have beds without bedsheets, linens, or pillows. LPA observed 1 resident laying on a mattress without any pillows or blankets.

According to an interview with Staff 1 (S1), there are plenty of extra linens in the closet. S1 reported they are unsure why it was not replaced after the soiled bedsheets were taken off the bed. S2 reported that staff clean the bedsheets every day. S2 said they will put the bedsheets on after they clean. S2 showed LPA the closet where extra linen supplies were observed. LPA observed multiple bed covers, bed sheets, and bed comforters that can be utilized.

According to an interview with the Reporting Party (RP), RP observed the facility. RP observed a resident on a bed that did not have any bedsheets. RP observed another bedroom that had two beds with out anything on them.

The observations from the RP prior visit were similar to LPA's observation on 05/29/2024.

Based on observations and interviews, the preponderance of evidence standard has been met, therefore the Department has determined the allegation of Facility staff do not ensure residents have bedsheets to be substantiated.

Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided.

An exit interview was held with Administrator Beatrice Clark, and a copy of the report was left at the facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20240528100935
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: BEATRICE HOME CARE
FACILITY NUMBER: 342701286
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/12/2024
Section Cited
CCR
87303(a)(3)(C)
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87307 Personal Accommodations and Services (a)...(3)... supplies.. shall be readily available to each resident.... (C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads... this requirement was not met as evidenced by:
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Licensee stated an in-service training will be conducted with all staff regarding proper procedures when changing out bed linens. LPA Valerio to receive a copy of the in-service sign in sheet by POC due date.
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Based on observations and interviews, the licensee did not ensure 3 out of 5 bedrooms to have clean linen available for the residents to use at all times. This poses a potential health, safety, and 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: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4