107209048-4-18-2022-24-AS-SPIY-C8GS9Q-20211105134108

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209048
Report Date: 11/02/2021
Date Signed: 04/18/2022 11:45:17 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/06/2021 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210406121011

FACILITY NAME:	COMPASS POINTE MEMORY CARE		FACILITY NUMBER:	107209048
ADMINISTRATOR:	HURLEY, DONNA		FACILITY TYPE:	740
ADDRESS:	5425 W. SPRUCE AVE.		TELEPHONE:	(559) 840-9347
CITY:	FRESNO	STATE: CA	ZIP CODE:	93722
CAPACITY:	36	CENSUS: 35	DATE:	11/02/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Donna Hurley		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Resident's call light was not reachable to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility to deliver the complaint investigation findings. LPA met with Administrator Donna Hurley.

The Department has investigated the complaint alleging: Residents call light was not reachable to resident. On 4/7/2021 Licensing Program Analyst (LPA) observed R1’s call light button to be on the floor and unreachable. During an interview R1 confirmed that assistance is provided when R1 calls out. Per AD, the location of R1's room is intentional as it is located near a common area where multiple staff are able to respond to and frequently check in. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. The allegation is UNSUBSTANTIATED.

A copy of this report was provided and an exit interview was conducted with Donna Hurley.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021

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 5

Citations on this Visit Report are Under Appeal!

Control Number 24-AS-20210406121011

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: COMPASS POINTE MEMORY CARE	FACILITY NUMBER: 107209048
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/02/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES	PLAN OF CORRECTIONS(POCs)
Under Appeal Type B CCR	1 2 3 4 5 6 7	1 2 3 4 5 6 7
	1 2 3 4 5 6 7	1 2 3 4 5 6 7
	1 2 3 4 5 6 7	1 2 3 4 5 6 7
	1 2 3 4 5 6 7	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/06/2021 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210406121011

FACILITY NAME:	COMPASS POINTE MEMORY CARE		FACILITY NUMBER:	107209048
ADMINISTRATOR:	HURLEY, DONNA		FACILITY TYPE:	740
ADDRESS:	5425 W. SPRUCE AVE.		TELEPHONE:	(559) 840-9347
CITY:	FRESNO	STATE: CA	ZIP CODE:	93722
CAPACITY:	36	CENSUS: 35	DATE:	11/02/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Donna Hurley		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Resident sustained pressure injury while in care
Resident suffered numerous wounds while in care
Staff handled resident in a rough manner causing injury

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility to deliver the complaint investigation findings. LPA met with Administrator Donna Hurley.

The Department has investigated the complaint alleging: Resident sustained pressure injury while in care. The Department conducted interviews of R1’s Home Health Agency personnel, R1’s family members and facility personnel. The Department conducted a records review of R1’s facility file, Home Health record and Kaiser Medical Record. Based on interviews conducted and records review, R1’s diagnoses can cause swelling and skin related injury. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. The allegation is UNSUBSTANTIATED.

See LIC9099-C for continuation

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021

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

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 24-AS-20210406121011

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: COMPASS POINTE MEMORY CARE	FACILITY NUMBER: 107209048
	VISIT DATE: 11/02/2021

NARRATIVE

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The Department has investigated the complaint alleging: Resident suffered numerous wounds while in care. The Department conducted interviews of R1’s Home Health Agency personnel, R1’s family members and facility personnel. The Department conducted a records review of R1’s facility file, Home Health record and Kaiser Medical Record. Based on interviews conducted and records review, R1’s diagnoses can cause swelling and skin related injury. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. The allegation is UNSUBSTANTIATED.

The Department has investigated the complaint alleging: Staff handled resident in a rough manner causing injury. The Department interviewed R1 who provided inconsistent statements related to the allegation. Based on interview, Home Health Nurses and Therapists met with R1 multiple times weekly and did not report concerns or abuse. The facility Wellness Director reported that due to R1’s diagnosis, R1 was at high risk for skin tears and breakdown. Based on record review of R1’s Kaiser Medical Record, R1 reported being satisfied with the facility’s care and did not note any concerns. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. The allegation is UNSUBSTANTIATED.

A copy of this report was provided and an exit interview conducted with Administrator

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021

LIC9099 (FAS) - (06/04)

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