345003010-11-12-2024-59-AS-MSEY-DAZNQN-20241114094009

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345003010
Report Date: 11/12/2024
Date Signed: 11/12/2024 01:30:17 PM

Unfounded

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
08/13/2024 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20240813143012

FACILITY NAME:	OHANA CARE HOME		FACILITY NUMBER:	345003010
ADMINISTRATOR:	MITITI, DAN		FACILITY TYPE:	740
ADDRESS:	8254 MOSS OAK AVE		TELEPHONE:	(916) 725-8784
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 4	DATE:	11/12/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Dan Mititi, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff is physically abusing resident.
Staff are not providing adequate food service to residents.
Staff are locking residents in their rooms.
Staff are inappropriately administering sleeping aids to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conclude the investigation and deliver findings for a complaint received on August 13, 2024. LPA met with Dan Mititi, Administrator, and stated the reason for today's inspection. State Investigator, Rosemary Chavez, accompanied LPA to observe today's inspection. LPA observed (2) residents awake in the common area and (2) residents resting in their rooms. LPA was informed there are currently (3) residents under hospice care and observed a hospice nurse and chaplain arrive during the inspection.

During the course of the investigation, the Department interviewed the Administrator, a hospice nurse, Chaplain, and social worker; (3) family members, and (3) residents. Medication lists were reviewed for each resident (R1-R4) who resided at the care home when the complaint was received. The facility's food supply and resident door handles were observed on 8/14/24 and on 11/12/24. Resident's ankles were observed with the Administrator and the hospice nurse present on 11/12/24.

The results of the investigation is as follows:

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

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 59-AS-20240813143012

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: OHANA CARE HOME	FACILITY NUMBER: 345003010
	VISIT DATE: 11/12/2024

NARRATIVE

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9099C-1.. Allegation: Staff is physically abusing resident. The allegation states that staff (S1) hurts resident (R1's) ankles. No other details were provided.

Resident (R1) was not able to be interviewed on 8/14/24 or on 11/12/24, due to moving from the facility for financial reasons on/around 9/30/24. LPA reviewed hospice paperwork, dated 8/5/24, that resident had been admitted for late affects of a stroke. LPA was not able to speak to (R1's) family member after two attempts.

LPA spoke to a hospice chaplain, on 11/12/24, while he was visiting the facility. The chaplain stated (R1) was under hospice care while she lived at the facility, and he spoke to her on several occasions. The chaplain indicated (R1) was "really disconnected from reality" when she lived at the facility and was in the process of having her medications adjusted to help prevent hallucinations. The chaplain indicated he actually spoke to (R1) yesterday, 11/11/24, when visiting a skilled nursing facility, and (R1) seems better and was "very coherent" and misses living at the facility. LPA observed the chaplain to speak to (3) current residents (R2, R3 and R5), who are under hospice care during today's inspection. The chaplain indicated he has never observed any residents to appear abused in any way, has no concerns, and residents are "well taken care of".
LPA and the Administrator observed residents' ankles on 11/12/24 for residents (R2, R3 and R4). LPA did not observe any bruising on any of the residents. LPA spoke with a hospice nurse in person, on 11/12/24, who indicated she has been attending to these (3) residents for months and she is a mandated reporter, and she has not seen any abuse at the facility. The nurse explained that resident (R3) has edema on their legs instead of bruising and (R3) and the other residents are well taken care of, and the Administrator provides a lot of collaboration with the hospice agency. A hospice social worker indicated that she has "no concerns regarding the care at the facility" and other hospice staff have "not observed any issues of concern".

Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without reasonable basis.

Allegation: Staff are not providing adequate food service to residents. The allegation states that residents are not fed enough and are given Jell-O, Pepsi, and water.

A hospice social worker stated she has "seen snacks, meals and drinks available to residents" when visiting the facility. One family member of a resident stated she visits regularly and has never seen the facility serve Jell-O, or Pepsi, and the food is wonderful. Another resident's family member stated the facility serves balanced meals, the food looks delicious, and his relative has been gaining weight since moving in.
*cont on 9099C-2...

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 59-AS-20240813143012

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: OHANA CARE HOME	FACILITY NUMBER: 345003010
	VISIT DATE: 11/12/2024

NARRATIVE

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*9099C-2... A third resident's family member stated she is not aware of Jell-O being served but her relative likes sweets and the facility provided a special meal for her relative's birthday, as requested. The Administrator indicated the facility does not serve Jell-O, but serves pudding, and Pepsi was only served to (R1), who requested it. A hospice nurse stated she has seen good meals, including breakfast and lunch, when she visits, and snacks available all the time.

The facility's food supply was observed on 8/14/24 and on 11/12/24. Both the main refrigerator and spare refrigerator contained the required 2+ days of perishable food, including fresh produce. The pantry displayed 7+ days of non-perishable food on hand, and there is a snack cart with snack food and water in the dining area. LPA observed a hot lunch being served on 11/12/24 which included soup, cracker, a grilled cheese sandwich, and pudding.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without reasonable basis.

Allegation: Staff are locking residents in their rooms. The allegation states that residents doors are locked at night and the staff can’t go check on them.

Resident doors handles were observed on 8/14/24 and on 11/12/24 and were not observed to have a locking mechanism. Photos were taken on 8/14/24. The Administrator confirmed resident doors are never locked and residents are checked every 2-3 hours during the night time shift to ensure they are properly rotated and for incontinent care. The Administrator indicated residents can call for assistance using a call button.

Residents who were able to be interviewed indicated they receive assistance when it's requested. Family members who were interviewed indicated they have not noticed if resident doors have a locking mechanism on them. The hospice chaplain, nurse and social worker all indicated that residents are well taken care of, and they do not have any concerns of residents being neglected.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without reasonable basis.
*cont on 9099C-3...

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20240813143012

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: OHANA CARE HOME	FACILITY NUMBER: 345003010
	VISIT DATE: 11/12/2024

NARRATIVE

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9099C-3... Allegation: Staff are inappropriately administering sleeping aids to residents. The allegation states that residents are given sleeping medication, so they sleep all day.

The Administrator indicated residents are only given medications that are prescribed. A resident's family member stated residents are always active and awake when visiting the facility, and the facility is a nice place to live. Another resident's family member stated their family member is always awake when visiting.

A hospice nurse indicated that residents' vitals would be indicative if residents were being given sleep medication(s). The nurse indicated that the residents she visits have consistent vitals and provided vitals for (R2) and (R3) today as 128/84 and 132/89, and stated (R5) takes sedative medications due to behaviors and provided vitals of 98/63 today. Administrator stated (R5) still have severe emotional anxiety, but the hospice medications are helping greatly. (R5) is being monitored by hospice nurses and staff 5 times weekly.
The nurse stated she visits the facility once a week and a second nurse visits weekly as well, and asserted she has "never seen any abuse and would report it if I did".

The chaplain stated to LPA on 11/12/24 that he has no concerns with (R2) and (R3).

LPA observed residents (R2), (R3) and (R4) to be awake during most of today's inspection. LPA was able to briefly communicate with (R5) who was resting and listening to basketball.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without reasonable basis.

There are no citations issued in this report and the allegations are being dismissed.

Exit interview. Copy of report provided to the Administrator.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4