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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345002850
Report Date: 11/08/2023
Date Signed: 11/08/2023 02:37:18 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
10/10/2023 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20231010090536
FACILITY NAME:ECLIPSE HOME CARE IIFACILITY NUMBER:
345002850
ADMINISTRATOR:SAEGER, MAGDALENAFACILITY TYPE:
740
ADDRESS:137 YANKTON ST.TELEPHONE:
(916) 985-8851
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:6CENSUS: 5DATE:
11/08/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator Magdalena SaegerTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Staff neglect resulted in resident developing worsening pressure injuries.
INVESTIGATION FINDINGS:
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On 11/8/23, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Magdalena Saeger.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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 3
Control Number 59-AS-20231010090536
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: ECLIPSE HOME CARE II
FACILITY NUMBER: 345002850
VISIT DATE: 11/08/2023
NARRATIVE
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Staff neglect resulted in resident developing worsening pressure injuries.

Interviews and records review indicated that over a nine-day period (9/16/2023 - 9/25/2023), facility staff failed to seek medical care intervention, until a Nurse Practitioner came to the facility on 9/25/2023. During the nurse visit to R1 on 9/25/2023, the nurse examined and described R1’s wound as unstageable. Interviews and documentation indicated Nurse Practitioner instructed Administrator on getting Home Health and Hospice involved, which Administrator verbalized understanding. Due to R1’s insurance not taking effect in California, the facility waited a couple more days before sending R1 to the Emergency room on 9/28/23. Facility staff did not contact 911 as soon as the wounds were noticed, nor did they get immediate care for R1 as soon as the wounds were observed. The Nurse Practitioner felt R1’s pressure wounds required immediate medical attention and advised the facility to get Home Health out as soon as possible. Since R1 was documented as being frail with limited ability to move on their own, facility staff should have observed R1’s pressure wounds worsening and contacted a doctor or the Emergency room as soon as possible, but facility failed to do that. It has been concluded that facility staff did not seek timely medical attention for R1. Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, a deficiency is cited on the attached 9099-D page.

Exit interview conducted. Appeal Rights and copy of this report has been provided to facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20231010090536
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: ECLIPSE HOME CARE II
FACILITY NUMBER: 345002850
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/09/2023
Section Cited
CCR
87466
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87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This was not evidenced by:
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Licensee agrees to provide CCL a statement of understanding stating facility has reviewed Title 22, Division 6; Chapter 8, Article 8 by POC Date- 11/9/23.
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The facility failed to ensure that the resident’s medical needs were met in that R1 developed unstageable ulcers while under the care of the facility; the facility failed to seek timely medical care for the condition between 9/16/2023 to 9/28/2023 which poses an immediate health and safety risk to residents in care.
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Failure to submit Proof of Correction (POC) by Plan of Correction date may result in civil penalties.
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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: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3