157203336-6-15-2021-24-AS-SPIY-C47QBU-20210621120207

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157203336
Report Date: 06/11/2021
Date Signed: 06/15/2021 02:32:23 PM

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
04/14/2021 and conducted by Evaluator Katie Brown

COMPLAINT CONTROL NUMBER: 24-AS-20210414084721

FACILITY NAME:	GOLDEN CASTLE ASSISTED LIVING		FACILITY NUMBER:	157203336
ADMINISTRATOR:	BRIZUELA, PAULA MARIBEL		FACILITY TYPE:	740
ADDRESS:	2607 MOUNT VERNON AVENUE		TELEPHONE:	(661) 871-8133
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93306
CAPACITY:	49	CENSUS: 36	DATE:	06/11/2021
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Paula Maiibel Brizuela		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not seek timely medical care for resident
Resident lost significant amount of weight while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown contacted the facility via telephone to deliver the investigation findings due to COVID-19 and pre-cautionary measures.

The Department has investigated the complaint alleging: Staff did not seek timely medical care for the resident. Based on interview with R1’s Case Manager, the facility Administrator and S1 the Department was not able to confirm that the facility was aware of the appointments that were reported as “no call no show” and missed by R1. During the interviews, it was confirmed that during the time described, appointments were primarily performed via telephone or video due to Covid-19 in person restrictions. Record review of the facility appointment log indicate R1 was transported to appointments or R1 participated in tele-appointments. R1’s Case Manager escorted R1 to a Primary Physicians appointment on 4/1/21 where R1 was transported to the Emergency Room for evaluation.

See LIC 9099-C

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: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

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 24-AS-20210414084721

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: GOLDEN CASTLE ASSISTED LIVING	FACILITY NUMBER: 157203336
	VISIT DATE: 06/11/2021

NARRATIVE

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Interview and records review of the hospital issued “Discharge Instructions” confirm the diagnosis that was evaluated. R1 was not admitted to the hospital and returned to the facility same day with follow up care instructions, no changes to medications and recommendation to schedule a follow up appointment with the Primary Physician which occurred on 4/13/21. The allegation is UNSUBSTANTIATED. 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 Department has investigated the complaint alleging: Resident lost significant amount of weight while in care. Based on record review of weight history provided by the Primary Physician’s office and the Resident Weight Record provided by the facility, it was confirmed that R1 lost weight while in care of the facility. There was no evidence found that Physician made recommendations or a treatment plan that the facility did not follow regarding weight loss. Review of the Pre-Placement Appraisal states that R1 was “very thin” prior to admission. R1’s Case Manager stated in an interview that R1’s medical conditions were not managed under a Physician at R1’s previous placement and that R1 has been very thin for as long as R1 has been in the caseload. In review of Office Clinic Notes dated 5/7/21, the Physician documented “since patient has been losing too much weight it may be worth stopping the “named medication” as it can cause weight loss. At this visit, the “named medication” was stopped and orders for a different treatment plan were made. Based on interview with the Administrator, S1 and Case Manager, the Administrator communicated with the Case Manager and informed of R1’s weight loss and ongoing medical conditions. The allegation is UNSUBSTANTIATED. 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.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

LIC9099 (FAS) - (06/04)

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