Complaint Investigation Report

342700471-11-2-2023-59-AS-KHOS-CXB2PH-20231105163423

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO NORTH ASC , 9835 GOETHE ROAD, SUITE 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

09/26/2023 and conducted by Evaluator Sarena Keosavang

COMPLAINT CONTROL NUMBER: 59-AS-20230926154214

Staff do not assist residents with showering.

On 11/02/2023, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to deliver final finding Community Care Licensing received on 9/26/2023. LPA met with Executive Director, Ricky David, and explained the purpose of the visit. The Department interviewed facility staff and obtained pertinent documents such as, resident’s (R1) physician’s report and service plan. According to R1's phsycian's report, R1 is unable to bathe self. According to R1's service plan, R1 requires hands on assistance from one staff two times weekly. Interview statement received from staff indicated, staff were unable to assist R1 with showers on scheduled day. Staff indicated facility was experiencing staffing shortages. Interview statement received from ED indicated there were two showers scheduled for Saturday, 9/23/23. There were two caregivers and one Med Tech scheduled for that shift. Shower was rescheduled for another day due to staff call out. Interview statement received from R1 indicated, R1 did not receive assistance with showers on scheduled days. Based on interviews and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of regulations, Title 22. Deficiencies are being cited on the attached LIC9099D. Appeal rights provided. Exit Interview conducted and report provided.