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Inspection visit

complaint

ROSELEAF OROVILLELicense 0450027731 citation on this visit
1 citation recorded

Inspector’s narrative

What the inspector wrote

Residents are spoken to in an inappropriate manner. – SUBSTANTIATED It was reported that staff have heard and seen Staff 4 (S4) yelling at residents. Three staff stated they have witnessed S4 yelling at residents. Staff stated that S4 was subsequently terminated. It was determined that Staff 4 yelled at a resident and was terminated. Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. Exit interview conducted and a copy of the report was provided to COO Diania Bingham. Failure to report per reporting guidelines - UNSUBSTANTIATED It was reported that there was a medication error, where the wrong medication was given to Resident 1 (R1) and Resident 3 (R3) and not all medication errors are being reported to Licensing. LPA previously substantiated the medication error for R3 on 3/19/2024 complaint 59-AS-20240227084128, this incident was reported to licensing. During the investigation concerning the medication error for R1, LPA interviewed R1 who stated staff gave them the wrong medication. R1 stated S1 is the one who caught the mistake after it was given. LPA interviewed S1 who stated that the med tech thought they dispensed the wrong medication to R1 and it was reported to the administrator in training who investigated and determined that the correct medication was dispensed to R1. S1 stated it was not a med error so no incident report was submitted to licensing. It was determined that no medication error occurred for R1 and therefore an incident report was not required to be submitted to licensing. This allegation is unsubstantiated.

Citations

3 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87506(a)Type B

    87506(a) Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff. This requirement was not met as evidenced by: Based on interviews and document review it was determined that the paper file for R1 was not on file and the facility had not entered the resident’s record into their database where it could be accessed by facility staff. This resulted in staff not being able to provide EMS with the identifying records that are required by EMS in order to transport a resident to hospital. This poses a potential health and safety risk to residents in care.

  • 87465(a)(4)Type A

    87465(a)(4) Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interviews and document review it was determined that R1 ran out of multiple medications for a period ranging from 8 to 18 days. This poses an immediate health and safety risk to residents in care.

  • 87468.1(a)(1)Type B

    87468.1 (a)(1) Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff. This requirement was not met as evidenced by: Based on interviews it was determined that S4 yelled at residents. This poses a potential health and safety risk to residents in care.

FAQ · About this visit

Common questions about this visit

What happened during the April 23, 2024 inspection of ROSELEAF OROVILLE?

This was a complaint inspection of ROSELEAF OROVILLE on April 23, 2024. 1 citation were issued: 1 Type B.

Were any citations issued to ROSELEAF OROVILLE on April 23, 2024?

Yes, 1 citation was issued (0 Type A, 1 Type B). The first citation was for: "87506(a) Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for ..."

What type of inspection was this?

This was a complaint inspection. Complaint inspections are triggered when someone reports a concern about the facility to CCLD.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.