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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 500310664
Report Date: 10/07/2024
Date Signed: 11/12/2024 10:34:39 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
08/20/2024 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20240820100618
FACILITY NAME:ST. THOMAS RETIREMENT CENTERFACILITY NUMBER:
500310664
ADMINISTRATOR:SR.BASIMA MARGARET HOMAFACILITY TYPE:
740
ADDRESS:2937 NORTH BERKELEY AVENUETELEPHONE:
(209) 634-7252
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:49CENSUS: 37DATE:
10/07/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator Sister Margaret HomaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff are not allowing resident to have phone calls from family
INVESTIGATION FINDINGS:
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On 10/04/2024, LPA Campbell arrived unannounced to the facility to close a complaint. LPA Campbell met with Administrator Sister Margaret Homa and explained the purpose of the visit.

Regarding the allegation that staff are not allowing resident to receive phone calls, R1’s POA installed a landline in R1’s room and blocked some family members to prevent them from calling R1. Upon review of the POA document, it was found that R1 had a healthcare POA and this did not include decisions over who R1 could speak to on the phone. When the RP attempted to contact R1 through the landline and was blocked, RP called the facility and asked them to check if their grandmother’s phone was off the hook. At no point did the facility suggest the RP could call the facility to speak to R1 during this inquiry.

Based on interview with S1, LPA Campbell explained that denying RP the option to speak to R1 would be a violation of R1’s personal rights. Therefore, this allegation has been SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
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 3
Control Number 27-AS-20240820100618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ST. THOMAS RETIREMENT CENTER
FACILITY NUMBER: 500310664
VISIT DATE: 10/07/2024
NARRATIVE
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The following deficiency : Personal Rights 87468.1(a)(14), has been cited and appeal rights were given to the administrator. Per the California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies were observed and noted. Failure to correct any deficiencies will result in additional civil penalties.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20240820100618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ST. THOMAS RETIREMENT CENTER
FACILITY NUMBER: 500310664
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2024
Section Cited
CCR
87468.1(a)(4)
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87468.1(a)(4) Personal Rights of Residents. Residents shall have all of the following personal rights: (14) to have reasonable access to telephones, to both make and receive confidential calls.
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-Provide a statement of understanding for 87468.1(a)(4).
-The facility will inform all incoming callers that there is a facility phone for all residents to receive confidental calls and provided the conact number and review POA for residents.
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Based on interviews, the licensee did not ensure that a resident could receive confidential calls by immediately informing callers of the facility phone that was available.
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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: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
LIC9099 (FAS) - (06/04)
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