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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701286
Report Date: 09/17/2024
Date Signed: 09/17/2024 04:20:21 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
06/05/2024 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240605150140
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:
09/17/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Beatrice ClarkTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Facility staff do not do activities with the residents
Facility floor is a tripping hazard
Facility shower is in disrepair
Facility records are not available and maintained
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint findings. LPA Valerio met with Administrator Beatrice Clark, and explained the purpose of the visit.

The investigation consisted of interviews with staff, interviews with residents, records review, and observations. The following has been determined as it related to the above-mentioned allegations.

Facility staff do not do activities with the residents

LPA Valerio observed the facility on 06/13/2024, 07/02/2024, 07/23/2024, and 08/29/2024. During those visits, LPA did not observe staff conducting activities with the residents. Each time LPA visited, there was one staff on shift. The staff member was busy preparing meals, completing household chores, assisting residents with Activities of Daily Living (ADLs), and assisting with any outside agency visits.
Continues on LIC 9099 - C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
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 7
Control Number 27-AS-20240605150140
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: 09/17/2024
NARRATIVE
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...continued from 9099

 LPA did not observe a time where staff could be made available to conduct an individualized activity with a resident. The only activity that was observed was staff turning on the television for residents to watch a show or movie or playing music on the television. 

According to an interview with S1, S1 stated the residents do not like the activity schedule and it has to be personal to each person. S1 stated they do activities. According to an interview with Administrator Beatrice, the facility does activities such as bingo days, music, or take them out to an outing. Administrator Beatrice stated that a staff member that used to work at the facility was the main person to do activities but that staff left earlier in the year.

Facility floor is a tripping hazard

On 06/13/2024, LPA Valerio observed the facility. The facility has a fire door located in between the living room and the back of the house where the resident rooms are located. The fire door is raised a few inches from the floor. On one side of the door way, there is a door threshold that acts as a ramp so residents can move from the resident rooms to the living area. However, if a resident where to go from the living room to the resident room area, a door threshold ramp is not present. During this visit, LPA Valerio observed a resident in a wheelchair attempting to go back to the bedroom. The resident was unsuccessful because the resident was unable to move the wheelchair across the door way.

According to Administrator Beatrice, the fire marshal required the fire door to be installed as such in order to be granted a fire clearance.

According to review of Regional office visit on 06/13/2023, the facility was required to install two thresholds on the fire door. Prior to receiving licensure, the deficiency was correct. However, based on LPA Valerio's observation there is only one door threshold instead of two.

Continues on LIC 9099- C, page 3...
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 27-AS-20240605150140
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: 09/17/2024
NARRATIVE
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...continued from LIC 9099 - C, Page 2

Facility shower is in disrepair

LPA Valerio observed the facility on 06/13/2024. The facility shower located bedroom 3 was observed to be in disrepair. The ramp leading in to the shower had tiles that were sunk into the floor and covered by a plastic shower skid matt. According to Administrator Beatrice, residents do not use the shower and it was in process of getting fixed. The facility has one other bathroom residents use to shower with staff assistance.  On 07/02/2024, LPA Valerio observed the facility shower to be in process of getting fixed. Residents were able to use the toilet but were restricted access to the shower until it was repaired. As of today's date, 09/17/2024, the shower has been fixed by the licensee.

Facility records are not available and maintained

During LPA's visit on 06/13/2024, Administrator Beatrice admitted that the files were not complete; however, she had the documents on her phone. Administrator Beatrice stated that residents got into the facility files and took all the papers out of the binder. LPA observed a tub full of paperwork for resident files and staff files.  Administrator Beatrice was not able to provide LPA copies of staff or resident files until 07/02/2024.

Based on interviews and observation, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8) 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 conducted, and a copy of the report was left at the facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 27-AS-20240605150140
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: 09/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2024
Section Cited
CCR
87219(a)
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87219 Planned Activities (a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include:...This requirement was not met as evidenced by:
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Licensee will send proof of conducting activities with residents and have staff document outings by POC due date.
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Based on LPA observation, the facilty did not conduct activities with residents during 4 out of 4 visits, which poses a potential health, safety, or personal rights risk to residents in care.
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Type B
10/21/2024
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement was not met as evidenced by:
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Licensee had the shower repaired. It was observed to be in good condition during LPA's visit on 07/02/2024. POC cleared.
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Based on interviews and observations, the licensee did not ensure 1 out of 2 showers were maintained in good condition, which 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: 09/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 27-AS-20240605150140
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: 09/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2024
Section Cited
CCR
87307(d)(6)
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87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement was not met as evidenced by:
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Licensee removed the entire threshold so that it is a flat surface. LPA observed the change during 09/17/2024. POC cleared.
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Based on observations and records review, The licensee did not ensure the firedoor was free from obstructions by having door thresholds on each side of the door. This poses a potential health, safety, and personal rights risk to resident in care
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Type B
10/21/2024
Section Cited
CCR
87506
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87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility ... This requirement was not met as evidenced by:
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Licensee submitted completed resident files to LPA Valerio during annual visit on 07/02/2024. POC cleared.
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Based on interviews and observations, the licensee did not ensure to maintain a complete record for all residents and staff, which poses a potential health, safety, and personal rights risk to resident 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: 09/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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
06/05/2024 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240605150140

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:
09/17/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Beatrice ClarkTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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2
3
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5
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9
Facility staff are not properly trained to care for the residents
Insufficient staff to meet the needs of the residents
Licensee allows non-fingerprinted staff to assist residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint findings. LPA Valerio met with Administrator Beatrice Clark, and explained the purpose of the visit.

The investigation consisted of interviews with staff, interviews with residents, records review, and observations. The following has been determined as it related to the above-mentioned allegations.

Facility staff are not properly trained to care for the residents

On 07/02/2024, LPA Valerio reviewed facility records regarding training conducted with staff for 2024. Staff 1 (S1) is main caregiver for the residents working 12 hours per day. The Administrator and Co-Licensee are reported to work evening shifts or on-call if shifts need to be covered. According to facility records, training hourly requirements for the year were met. Topics included dementia, reporting requirements, medications, and observations of residents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 27-AS-20240605150140
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: 09/17/2024
NARRATIVE
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Insufficient staff to meet the needs of the residents
On 06/13/2024, Resident 1 (R1) was observed playing with a trash can in a bathroom, climbing on a bed in another resident's room, aimlessly walking around the facility , and trying to exit the exit door to the backyard. During this time, S1 was observed doing the facility laundry and placing clean bedsheets on resident bedrooms.

On 08/29/2024, LPA Valerio waited outside the facility for 10 minutes before staff answered the door. According to S1, S1 was cleaning a resident room and could not answer the door. Residents were observed sitting at the dining table and waved to LPA. LPA Valerio observed S1 assisting R1 with a shower. While this was happening, two residents were finishing their breakfast, one was in their room watching television, and another was sleeping. The Administrator and S2 arrived to the facility to meet with LPA; however, if they were not present, S1 would have pre-occupied for 15-20 minutes and unable to assist any other resident in care.

According to Administrator Beatrice, the facility has enough staff. Beatrice states she is always there and goes back and forth between the Elk Grove Facility and Galt Facility. Staff 2 (S2) comes during the evening after S1 has completed the shift. According to an interview with S1, S1 feels that S1 can take care of all the residents and all duties of the facility.

Due to cognitive impairment of the residents, LPA was only able to successfully interview Resident 2 (R2). R2 stated that it takes about 5 minutes for staff to respond to calls. R2 does not have any concerns of the facility and stated staff help R2.

Licensee allows non-fingerprinted staff to assist residents
It was reported to the Regional Office that the facility had an employee who is not cleared to work in the facility. LPA Valerio observed the facility on 06/13/2024, 07/02/2024, 07/23/2024, and 08/29/2024. LPA observed all staff present in the facility to have a finger print clearance and associated to the facility.

Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of report was left at the facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7