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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701286
Report Date: 12/20/2024
Date Signed: 12/20/2024 11:28:48 AM

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
10/17/2024 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241017164426
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:
12/20/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Facility Staff TIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff did not receive all required training(s).
Staff do not provide appropriate supervision to residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint investigation findings. LPA Valerio met with facility staff Etta Mae, and explained the purpose of the visit.

The following has been determined as it relates to the aforementioned allegations. The investigation consisted of review of facility files, LPA observation, resident interviews, and staff interviews.

Staff did not receive all required training(s).
LPA Valerio reviewed staff training submitted by Administrator Beatrice. Administrator submitted training files for facility staff 1 (S1) and staff 2 (S2) . LPA Valerio reviewed the facility roster. LPA did not observe Staff 2 (2) on the associated list for Beatrice Home care.

Continues on LIC 9099 - C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
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 5
Control Number 27-AS-20241017164426
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: 12/20/2024
NARRATIVE
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Continued from LIC 9099

LPA Valerio reviewed facility files for Staff 1 (S1). LPA observed completed training certificates for the following topics: Medication training - 01/10/2024, Dementia Care Staff Training - 02/02/2024, Osha training - 01/20/2024, 40 hour orientation training - completed, Oxygen training - 02/01/24, Orientation training - 01/18/24 - 02/01/2024, and Disaster and Emergency Training - 02/01/2024. All training were instructed by Administrator Beatrice.
On 11/26/2024, LPA Valerio observed Staff 3 (S3) working at the facility. Licensee/Administrator Beatrice was cited for California Code of Regulations (CCR) Title 22, Section 87411(g)(2) for not obtaining a fingerprint clearance for S3 prior to working at the facility. According to an interview with S3, S3 was there shadowing the main staff, S1. LPA Valerio learned during this visit that S3 was assisting residents over the weekend. When S3 was questioned, S3 stated the residents are going to get S3 in trouble. Administrator Beatrice confirmed during this visit that paper work and training was still in the process for S3. S3 did not have any prior training or experience. Therefore, the allegation of Staff did not receive all required training is substantiated.

Staff do not provide appropriate supervision to residents in care.
On 10/24/2024, LPA Villanueva observed the facility to be in disrepair in Resident 1's (R1) room. On 11/05/2024, the facility was cited for the allegation facility is in disrepair. On 11/05/2024, LPA Valerio observed R1's bedroom. LPA observed the holes next to the electrical socket to be repaired; however, the electrical socket was missing a cover. LPA observed the scratches on the window frame and bed frame still is disrepair. LPA Valerio interviewed staff regarding the R1's behaviors. According to the Administrator, R1 has had these behaviors but nothing has worked. They will fix the facility and R1 will go and do it again. LPA Valerio interviewed S1. S1 stated they try to give one hand activity to R1, but R1 will try to eat it. The amount of damage done, such as digging into the window seal and walls, show that the facility is not supervising R1 or attempting to redirect resident. During LPA's visits, S1 has been on shift without assistance to provide care and supervision to up to 6 residents while conducting daily activities.

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: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20241017164426
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: 12/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/20/2025
Section Cited
CCR
87411(c)
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87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training.... This requirement was not met as evidenced by:
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Licensee to send completed training for Staff 3 by POC due date
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Based on observations, the licensee did not ensure Staff 3 had required training prior to working with residents in care, which poses a potential health, safety, and personal rights risk to residents in care.
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Type B
01/20/2025
Section Cited
CCR
87468.2(a)(4)
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87468.2... (a)... residents...shall have all of the following personal rights:(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by:
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Licensee to send LPA a detailed plan of how the facility will increase staff care and supervision to ensure all resident's needs are met. LPA to receive plan by POC due date.
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Based on observation, records review, and interviews, the licensee did not ensure to provide care and supervision to R1 to ensure R1 did not engage in potential harmful behaviors.
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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: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
10/17/2024 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241017164426

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:
12/20/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Facility Staff TIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
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9
Injections being administered by unqualified staff.
Administrator does not spend sufficient number of hours at the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint investigation findings. LPA Valerio met with facility staff Etta Mae, and explained the purpose of the visit.

The department has determined the following as it relates to the aforementioned allegations. The investigation consisted of LPA observations, records review of resident files, and interviews with staff.

According to an interview with an Outside Agency (OA), the facility is using unqualfied staff to administer insulin injections to residents in care.

LPA Valerio conducted an interview with Adminsitrator Beatrice and Staff 1 (S1). According to both interviews, there are no residents at the facility who receive injections or need insulin.
Continues on LIC 9099 - C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
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 5
Control Number 27-AS-20241017164426
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: 12/20/2024
NARRATIVE
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Continued from LIC 9099 - A

LPA Valerio reviewed resident records for Resident 1 (R1) - Resident 5 (R5). R1, R2, and R3 did not have injections listed on their medication list. R4 was observed to have tablets for medication. However, on a medication list from a previous rehabilitation center, there are 3 injections on the list. It says started date 06/18/2024 with no end date. There is a hand written note saying discontinue, but it is unclear if this was discontinued. On the LIC 602, there is an N/A next to able to administer own injections and yes to able to perform own glucose testing. On 12/20/2024, LPA Valerio went to observe R4's medication but learned R4 moved out of the facility. Administrator Beatrice did not provide a complete copy of R5's file and therefore, LPA was unable to determine if injections are provided. On 12/20/2024, LPA Valerio reviewed R5's medications. LPA did not observe injections present at the facility for R5.

Administrator does not spend sufficient number of hours at the facility.

On 10/24/2024, 11/05/2024, 11/26/2024, and 12/20/2024, LPAs observed Staff 1 (S1) on shift. LPAs did not observe Administrator Beatrice present when LPAs arrived at the facility. During each visit, Administrator Beatrice went to the facility after learning of arrival of the LPA. According to an interview with OA, anytime OA visits the facility, Administrator Beatrice is never there.

According to an interview with Administrator Beatrice, Administrator stated she is always here. She comes when it is necessary. For example, she will come in the morning, she will coming in the evening, or she will come to work the over night shift. Administrator Beatrice stated she travels from her facility in Elk Grove and her facility in Galt.

Based on all the information collected by the Department, although the allegation may have happened or is valid, here is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. 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: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5