079201083-8-15-2023-15-AS-YFLS-CVNN7M-20230914101257

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201083
Report Date: 08/15/2023
Date Signed: 08/15/2023 10:26:17 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/19/2023 and conducted by Evaluator Paris Watson

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230619085326

FACILITY NAME:	MONTECITO OAKMONT SENIOR LIVING		FACILITY NUMBER:	079201083
ADMINISTRATOR:	WONG, ELAINE		FACILITY TYPE:	740
ADDRESS:	4756 CLAYTON ROAD		TELEPHONE:	(925) 692-5838
CITY:	CONCORD	STATE: CA	ZIP CODE:	94521
CAPACITY:	230	CENSUS: 185	DATE:	08/15/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Elaine Wong, Executive Director		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff neglected resident resulting in multiple pressure injuries
Facility did not follow resident's care plan

INVESTIGATION FINDINGS:

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On 08/15/2023 at 10:00 AM, Licensing Program Analyst P Watson arrived unannounced deliver findings for the above allegations. LPA met with Executive Director, Elaine Wong and explain the purpose of the visit

During the course of the investigation the Department obtained documents. Documents including but not limited to: Resident roster, staff roster with contact information, staff schedule, resident care plans, physicians report, and shift notes.

It was alleged that Staff neglected resident resulting in multiple pressure injuries.

On 6/14/2023 Resident 1 (R1) was initiated into Hope Hospice and was inspected by a Hospice nurse, the hospice nurse observed R1 feet pressed against the bed frame, feet had deep open cuts/pressure related injuries. Hospice nurse also stated they observed an unstageable pressure wound on R1 coccyx.

Report continues on 9099 C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 725-7926
LICENSING EVALUATOR NAME: Paris Watson	TELEPHONE: (510) 622-2625
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20230619085326

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: MONTECITO OAKMONT SENIOR LIVING	FACILITY NUMBER: 079201083
	VISIT DATE: 08/15/2023

NARRATIVE

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However, on 6/13/2023 R1 was inspected by John Muir Home Visit Nurse Practitioner, who stated during their interview that R1 had a small red mark on coccyx that was not a definite wound. It was also determined that R1 did not have any wounds on the feet, the feet appeared to be dry and scaly. R1’s home health medical records stated that R1’s previous stage one pressure wound on the coccyx healed, then returned, and was probably stage two with slight scab, no exudate.

On 7/7/2023, the department interviewed multiple facility staff (S1, S2, S3 and S4), all staff denied seeing pressure wounds on feet. S3 stated that they never saw R1’s feet due to R1 keeping socks on and not letting staff change them. S3 also stated that they observed a pressure would on his lower back. Based on interviews with S2 and S3, staff would rotate R1 every 2 hours. It was also stated during interviews that since R1 was bed bound, it would take 2-4 staff to rotate R1 but facility staff ensured it was done.

It was alleged that Facility did not follow resident’s care plan.

During record review LPA observed that home health primary provided wound care when R1 had a pressure wound. John Muir Home Health would visit R1 3-4 times a week, every 2-3 months or as needed if the facility or R1 POA called. Based on record review, the facility staff provided assistance with all ADLs and transfers. Based on interviews with S4, R1 did not like to be moved or touched, was difficult and would grab on to the bed when staff tried to rotate him. S3 stated that after staff rotated him, he would move back into the original position and at times would move down causing his feet to touch the foot board.

Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 725-7926
LICENSING EVALUATOR NAME: Paris Watson	TELEPHONE: (510) 622-2625
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC9099 (FAS) - (06/04)

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