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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001498
Report Date: 10/08/2024
Date Signed: 10/08/2024 05:06:38 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
06/05/2024 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20240605141044
FACILITY NAME:CITRUS HEIGHTS TERRACEFACILITY NUMBER:
347001498
ADMINISTRATOR:TONI JONESFACILITY TYPE:
740
ADDRESS:7952 OLD AUBURN ROADTELEPHONE:
(916) 727-4400
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:45CENSUS: 43DATE:
10/08/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Magda Luis, Interim Administrator TIME COMPLETED:
05:05 PM
ALLEGATION(S):
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Staff do not distribute a resident's medication as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to complete a complaint investigation for a complaint received on June 5, 2024. LPA met with Magda Luis, Interim Administrator, and with Ashley Stahl, Resident Care Coordinator. LPA stated the reason for today's inspection.

During the course of the investigation, LPA interviewed the Administrator, Resident Care Coordinator, (5) care staff, (2) laundry/housekeeping staff, an outside care provider/nurse, and a family member of resident (R1). LPA reviewed multiple documents relating to (R1), including, the Pre-Appraisal, Admission Agreement, Physician’s Report, care plan, charting notes, and the Medication Administration Record (MAR).

The results of the investigation are as follows:

cont on 9099C-1..
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
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 59-AS-20240605141044
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: CITRUS HEIGHTS TERRACE
FACILITY NUMBER: 347001498
VISIT DATE: 10/08/2024
NARRATIVE
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9099C-1.. Allegation: Staff do not distribute a resident's medication as prescribed. Allegation states staff have not ensured that (R1’s) eye drops are administered, as ordered, for a year. The facility initially administered the drops but then resident's health care plan began to administer some of the dosages due to resident refusing. The order for Timolol was discontinued on 5/19/23 without the family member being informed or that the resident was refusing the drops, but was then reinstated a month later.

(R1's) family member emailed the Administrator on 2/14/24 to confirm if (R1) is still receiving daily eye drops, per doctor’s orders, stating that resident’s “lower eye lid is red and looks like it’s drooping more”, and the doctor indicated at the appointment earlier that day that her eye looks worse. The Administrator promptly responded that she had just confirmed with a Med-Tech that (R1) has refused eye drops all week and they have reached out to resident's health care plan.The Administrator stated she wasn’t aware that (R1) was refusing the eye drops, and she/staff will have to figure out another way to get resident to cooperate with the drops, as resident has become increasingly more resistant in allowing staff to administer medications and apply crème also.

Resident's care plan, dated 6/15/24, states “Resident needs extra distraction for medication time and eye drops. Health care plan is coming to do eye drops during the day time (2x/day), and the Administrator's suggestion is to do a part and then try again for another part, and do not try everything at once”.

Resident's family member stated she was told the facility stopped giving the eye drops due to resident refusing. The Administrator stated "(R1) was refusing a lot" and so daughter asked resident's health care plan to assist with the eye drops. Several staff interviews conducted on 7/3/24 confirmed that a representative from resident's health care plan will come to the facility to administer drops to resident daily, in the morning and afternoon, and facility staff will administer the drops in the evening and bedtime.

The MAR was reviewed for April - June 2024. MAR notes for April 2024 show resident refused the drops on 4/25/24 and 4/26/24. The MAR notes from 5/11/24 indicate the evening and bedtime drops were not given due to resident's health care provider not showing up. MAR notes from 5/15/24 note resident refused (3) different drops in the morning, but the health care provider would be administering them.

*cont on 9099C-2..

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20240605141044
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: CITRUS HEIGHTS TERRACE
FACILITY NUMBER: 347001498
VISIT DATE: 10/08/2024
NARRATIVE
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9099C-2.. June 2024 MAR shows resident was prescribed (3) drops and refused drops (4) times and (2) medications, Refresh Classic and Maxitrol (Ophth) were not available to be administered on 6/22/24 for the evening drops.

LPA spoke with a nurse from resident's health care program on 6/13/24. He stated he administers eye drops to other residents as well, confirming that resident (R1) "has an existing order" but his company obtained an "overriding order" for them to administer. This nurse explained that he is scheduled to show up at the facility, and if (R1) is at their program, then he will notify the nurse to give the drops to (R1) there. This nurse stated some residents may receive drops at the program, but he doesn't know about (R1) specifically.

LPA observed a Med-Tech staff administer eye drops to resident on 7/11/24 (around 12:00 pm), with (3) other staff assisting. LPA observed (R1) to verbally express she didn't want the eye drops, and tried to grab the Med-Tech's hand.

The MAR documentation reviewed shows resident (R1) missed scheduled dosages of eye drops in May 2024 and in June 2024 due to resident's health care provider not present to administer the medication, or the medication not being available.

Based on information obtained, LPA finds allegation to be SUBSTANTIATED - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.



Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) citation is issued on the 9099-D page.

Exit interview. Copy of report and appeal rights provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 59-AS-20240605141044
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: CITRUS HEIGHTS TERRACE
FACILITY NUMBER: 347001498
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/09/2024
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed.
This requirement is not met as evidenced by:
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Licensee/Administrator agree to conduct staff training on medication administration involving an outside care provider, refill protocols.
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Based on record review, the Licensee did not ensure that resident (R1) received eye drops as ordered on 5/11/24 (evening /bedtime doses) and on 6/22/24 (evening dose), which posed an immediate health and safety risk to residents in care.
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Administrator to discuss the training with the company nurse who will be in the building tomorrow, 10/9/24. Administrator will follow up with Dept to confirm a training day for staff. LPA stated 2 weeks can be given for staff training, or by 10/22/24.
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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: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5