347001696-4-26-2021-27-AS-KMKY-C2QR92-20210505124850

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001696
Report Date: 04/26/2021
Date Signed: 04/26/2021 04:21:49 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/15/2021 and conducted by Evaluator Melana Llopis

COMPLAINT CONTROL NUMBER: 27-AS-20210115163041

FACILITY NAME:	LA HONDA GUEST HOME		FACILITY NUMBER:	347001696
ADMINISTRATOR:	TORRES, MARGARITA		FACILITY TYPE:	740
ADDRESS:	3940 LA HONDA WAY		TELEPHONE:	(916) 944-8909
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 5	DATE:	04/26/2021
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Administrator, Neal Torres		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Resident did not receive bathing assistance for a period of time
Resident not administered medication as prescribed

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melana Llopis
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2021

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

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/15/2021 and conducted by Evaluator Melana Llopis

COMPLAINT CONTROL NUMBER: 27-AS-20210115163041

FACILITY NAME:	LA HONDA GUEST HOME		FACILITY NUMBER:	347001696
ADMINISTRATOR:	TORRES, MARGARITA		FACILITY TYPE:	740
ADDRESS:	3940 LA HONDA WAY		TELEPHONE:	(916) 944-8909
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 5	DATE:	04/26/2021
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Administrator, Neal Torres		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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9

Resident sustained bed sore while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Llopis contacted the facility unannounced on 04/26/2021 via telephone due to Covid-19 and precautionary measures to deliver complaint findings for a complaint the Department received on 01/15/2021. LPA spoke with the Administrator, Neal Torres and explained the purpose of the call.

Throughout the course of the investigation, LPA conducted multiple interviews, toured the facility, and reviewed documentation pertinent to the allegation listed above.
The complaint alleged that R1 developed a bed sore while in care due to the facility not changing their depends as needed. LPA spoke with R1's responsible party (RP) on 04/26/2021 who stated R1 resided at the facility from 06/10/2020 - 07/03/2020. During R1's stay, RP stated he never saw a bed sore on R1. RP stated when R1 returned home on 07/03/2020, RP did not see a bed sore. LPA spoke with Director of Care from Progressive Home Care on 04/26/2021 and reviewed R1's Progress Notes together. Progress notes incidate on 06/23/2020 and 07/01/2020, R1 had redness on R1's buttocks but no open wound. Director of Care defined a bed sore as "an open wound." Director of Care also stated "it is common for patients with incontinence who are immobile to develop redness however their goal is to prevent the skin from opening by applying a barrier cream." Further progress notes reviewed with Director of Care show barrier cream was being applied to the redness on R1's buttock during their residence at the facility.
***Continuation on LIC9099-C***

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melana Llopis
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 27-AS-20210115163041

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: LA HONDA GUEST HOME	FACILITY NUMBER: 347001696
	VISIT DATE: 04/26/2021

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Due to the information provided, LPA find the allegation: Resident sustained bed sore while in care to be UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted with Administrator, copy of report provided. Administrator to send a signed copy to LPA by 04/27/2021.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melana Llopis
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 27-AS-20210115163041

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: LA HONDA GUEST HOME	FACILITY NUMBER: 347001696
	VISIT DATE: 04/26/2021

NARRATIVE

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Allegation: Resident did not receive bathing assistance for a period of time

The complaint alleged resident was not receiving weekly showers. On 04/20/2021, LPA interviewed three (3) of five (5) residents in care who stated they receive bathing once a week or when they ask. Residents reported the facility will clean them in-between showers which includes wiping them down. Interviews with three (3) of three (3) staff on 04/20/2021 and 04/23/2021 reported the residents are showered once every Sunday and cleaned in-between showers as needed. Staff stated if the residents request an additional shower, a shower is provided. The facility did not have a shower record to be reviewed. No further evidence could be provided.

Allegation: Resident not administered medication as prescribed

The complaint alleged the resident was not receiving their medication at the appropriate time. On 04/20/2021 LPA interviewed three (3) of five (5) residents in care who stated they receive their medications and have not had any issues with receiving medications. On 04/26/2021 LPA conducted a medication audit for three (3) of five (5) residents in care and observed no errors. No further evidence could be provided.

Due to the above information, LPA finds the allegations Resident did not receive bathing assistance for a period of time and Resident not administered medication as prescribed to be UNSUBSTANTIATED, meaning
that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, and the findings are unsubstantiated.

Exit interview conducted with Administrator, copy of report and appeal rights provided. Administrator to send a signed copy to LPA by 04/27/2021.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melana Llopis
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4