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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397000839
Report Date: 09/20/2023
Date Signed: 09/22/2023 11:29:13 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
06/27/2023 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20230627104114
FACILITY NAME:MARY FRANCES HAT RESIDENTIAL FACILITYFACILITY NUMBER:
397000839
ADMINISTRATOR:LAURA REEVESFACILITY TYPE:
740
ADDRESS:14381 E. SARGENT ROADTELEPHONE:
(209) 334-6454
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:6CENSUS: 3DATE:
09/20/2023
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Laura Reeves, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Resident developed a pressure injury while in care due to lack of staff supervision.
INVESTIGATION FINDINGS:
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On 09/20/2023, Licensing Program Analyst Renee Campbell arrived at Mary Francis Hat Residential Facility unannounced to conclude investigation 27-AS-20230627104114. LPA met with Laura Reeves and explained the purpose of the visit.

In regards to the allegation, "Resident developed a pressure injury while in care due to lack of staff supervision", the Department confirmed R1's pressure wound was a result of a hospital stay and was not sustained at Mary Francis. The pressure wound was first noticed when R1 returned from a hospital stay from 6/8/2023 through 6/12/2023. The wound was not severe and it was being treated properly with creams, repositioning, and pillows. After another hospital visit on 6/16/2023, R1’s wound ruptured and when a Wound Care Nurse (N1) saw the wound afterwards, it was unstageable. Mary Frances staff enlisted the help of N1 to treat R1 and teach Mary Frances staff how to care for the wound. Per S1 and N1, R1’s pressure wound was a result of the Emergency room visit on 6/16/2023.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
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 2
Control Number 27-AS-20230627104114
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: MARY FRANCES HAT RESIDENTIAL FACILITY
FACILITY NUMBER: 397000839
VISIT DATE: 09/20/2023
NARRATIVE
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The investigation revealed the preponderance of evidence standards has not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was conducted with Administrator Laura Reeves and it was requested to sign todays report, and a copy of this report was provided.
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2