157208915-6-15-2023-24-AS-MHON-CTLN37-20230710100550

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208915
Report Date: 06/14/2023
Date Signed: 06/15/2023 07:58:09 AM

Unfounded

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
06/07/2023 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20230607104223

FACILITY NAME:	PALMS AT SAN LAUREN, THE		FACILITY NUMBER:	157208915
ADMINISTRATOR:	RICE, DOUGLAS		FACILITY TYPE:	740
ADDRESS:	5300 HAGEMAN RD		TELEPHONE:	(661) 218-8333
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93308
CAPACITY:	68	CENSUS: 65	DATE:	06/14/2023
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Doug Rice, Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Resident being left in soiled linins/diapers

INVESTIGATION FINDINGS:

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On 06/14/23, Licensing Program Analyst (LPA) L. Salazar contacted Administrator, Doug Rice to discuss the above allegation. LPA requested Resident R1's Hospice Care Plan and facility communication logs for the month of June 2023.

LPA reviewed conducted interviews and reviewed records. Records show R1 is currently receiving Hospice Care services. LPAs review of facility communication logs show R1 stated they did not want to be touched and did not want the caregiver to change their briefs on 06/02/23, 06/03/23, and 06/10/23. A review of hospice care notes show R1 has had a significant decline in their health and is refusing care, medication and is eating less than 25% of their meals. Hospice care is provided 3 days a week which includes treatment for Sacral wound care.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

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 24-AS-20230607104223

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: PALMS AT SAN LAUREN, THE	FACILITY NUMBER: 157208915
	VISIT DATE: 06/14/2023

NARRATIVE

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(Continued from 9099)

Interviews with Hospice state R1 has had increased agitation and behaviors R1 is refusing care and making accusations that caregivers are refusing to give meds. Multiple Care conferences with the nurses and facility staff have been documented that the allegations are not true.

Based on records review and interviews, we have found that the complaint was Unfounded, meaning that the allegation is false, could not have happened and or is without reasonable basis, therefore, we have dismissed the complaint. Exit interview conducted. No Deficiencies cited. A copy of this report was provided to Administrator.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

LIC9099 (FAS) - (06/04)

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