392700935-3-22-2022-27-AS-SDOB-CCTNBT-20220324101940

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700935
Report Date: 02/24/2022
Date Signed: 03/22/2022 01:41:14 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/10/2021 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20211210105225

FACILITY NAME:	BEATITUDES CARE HOME		FACILITY NUMBER:	392700935
ADMINISTRATOR:	NOLASCO, RICKY C.		FACILITY TYPE:	740
ADDRESS:	1639 UNITED ST.		TELEPHONE:	(209) 647-9701
CITY:	MANTECA	STATE: CA	ZIP CODE:	95337
CAPACITY:	6	CENSUS: 5	DATE:	02/24/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Ricky Nolasco		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not allow resident to make personal phone calls or speak with their friends.

Staff handled resident roughly causing bruising.

Staff did not ensure that resident received adequate mobility outside of bed.

Resident developed a pressure injury while in care.

Staff did not arrange for resident to see a dentist or doctor.
Facility does not provide a safe and comfortable environment for resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Unannounced complaint visit made out to this facility on 02/24/2022 by LPA Charlie Yang and was met by the facility live-in caregiver, Shannon McGurk, who was requested by this LPA to go ahead and contact the facility designated Administrator Ricky Nolasco to inform him that CCL was present at this time.
Current census was 5 residents.
Based on interviews and information gathered during the course of this investigation, It was learned that R1 did have access to the facility telephone and was able to make and receive calls. It was learned that facility personnel would pick up the phone and hand the phone over to R1 once it was determined that the call was for R1.
Based on interviews and information gathered during the course of this investigation, it was learned that R1 was often times combative and resisted assistance when facility staff were attempting to change or reposition R1 in bed. As a result of R1's resistance and aggressive behavior towards facility personnel, R1 would sustain injuries to her arms and hands through R1's actions. It was learned that R1 would sometimes hit nearby fixtures such as the bed rail or tray table that stretched across R1's bed. These actions by R1 would

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2022

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 2

Control Number 27-AS-20211210105225

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: BEATITUDES CARE HOME	FACILITY NUMBER: 392700935
	VISIT DATE: 02/24/2022

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

result in bruising and marks on R1's person. These marks and bruises were not the result of facility personnel mishandling or mistreating R1 as gathered through interviews and admissions.
Based on interviews and information gathered during the course of this investigation, it was learned that R1 had a durable power of attorney granted to R1's responsible party. It was learned that it was the responsibility of this responsible party to navigate R1's health care plan and make the necessary arrangements and appointments for R1's medical, dental, and vision needs. From statements and information gathered, appointments were previously set up but were not attended to by R1 since R1 refused the appointment and missed it. This has taken place on more than one appointment.
Based on interviews and information gathered during the course of this investigation, it was learned that R1 was, for the most part, content with her residency at this licensed care home. It was learned from R1 that there weren't any feelings of fear or discomfort with the level of care being provided at this time.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited at this time.

Exit Interview

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2