State'of California - Health and Human Services Agency Departrnent of Public Health

SECT|ON i+zc xonce Page 1 of 3

CITATIONNUMBER: 03-2225-0013152-S Date: 04l?512017 Timel

Type of Visit : Comptaint lnvestig.

YOU ARE HEREBY FOUND IN VIOI.ATION OF APPLICABLE lncidenUComplaint No,(s) : CA0035775S
CALIFORNIA STATUTES AND REGUI-ATIONS OR APPLICABLE
FEDERAL STATUTES AND REGULATIONS

Licensee Name: pggsville Point Health & Weltness Cenrer

LLC

Address: 600 Sunrise Avenue Rosevifle,CA 95661

License Number: 030000045 Type of Ownership: Limited Liability Company

Facility Name: Roseville Point Health & Wellness Center

Address: 600 Sunri$e Avenue Roseville, CA 95681
TeleDhone:
Facility Type' Skilled Nursing Facility Capacity: 9e
Facility lD: 030000004

SECTIONS CISSS AND NATURE OF VIOIjTIONS PENALTY ASSESSMENT EADLINE FOR

VIOL,ATED s800.00
/17 11:59 p.m.
1 d 1 8.9(a) CUSS B CITATION.. PATIENT R'GHTS
California Health and Safety Gode Section 1418.9
(a) lf the attending physician and surgeon of a resident in a skilled nursing facitity
prescribes, orders, or increases an order for an antipsychotic medication for the
resident, the physician and surgeon shail do both of the following:
(1) Obtain the informed consent of the resident for purposes of prescribing, ordering, or
increasing an order for the medication.
(2) Seek the consent of the resident to notifo the resident's interested famity member. as
designated in the medical record. lf the resident consents to the notice, the physician
and surgeon shall make reasonable attempts, either personally or through a deslgnee,
to notifu the interested family member, as designated in the medical record, within 4g
hours of the prescription, order, or increase of an order.

The following citation was written as a result of complainant appeal unit review for
complaint intake C400357756.

The facitity failed to meet the requirements for California Health and Safety Code
section 1418.9(aX2) when it failed to enstlre the physician notified the resident's
iesponsible party within 48 hours of the emergency order for Hatdot.

A review of the resident's facility facesheet identified Resident A's RP as her daughter.

Name ol Evalualor: Wthout admifting guilt, I hereby acknowledge

receipt of this SECTION 1424 NOTtCE
Eva Neth
Ql Specialist

Name:
Evaluator Title:

NOTE: IN ACCORDANCE WITH CALIFORNIA HEALTH AND SAFTEY CODE, FAILURE To coRREcT
VIOLATIONS IS GROUNDS FOR SUSPENSION OR REVOCATION OF YOUR LICENSE

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