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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191592599
Report Date: 05/16/2024
Date Signed: 05/16/2024 03:55:28 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/13/2024 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20240513113813
FACILITY NAME:FOUNDERS HOUSE OF HOPEFACILITY NUMBER:
191592599
ADMINISTRATOR:JAZELLE TURCATOFACILITY TYPE:
735
ADDRESS:18025 PIONEER AVE.TELEPHONE:
(562) 860-3351
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY:98CENSUS: 79DATE:
05/16/2024
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Administrator Gil MartinezTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Staff mismanaged residents' medication
Staff did not refill residents medication prescription in a timely manner.
INVESTIGATION FINDINGS:
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On 05/16/2024 at 09:31 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an initial complaint visit, to investigate the allegations listed above. LPA met with Administrator Gill Martinez and explained the reason for the visit.

During the visit, LPA reviewed medications for Client# 1 (C1) and Client# 2 (C2). LPA obtained client roster, staff roster, C1 and C2 physicians orders, C1 and C2 medication administration records (MAR). LPA also interviewed: the Administrator and a total of two (2) staff who shall be referred to as S1, and S2. LPA interviewed a total of 8 clients who shall be referred to as: C1 through C8.

Report continued on 9099c
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
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 3
Control Number 28-AS-20240513113813
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: FOUNDERS HOUSE OF HOPE
FACILITY NUMBER: 191592599
VISIT DATE: 05/16/2024
NARRATIVE
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The investigation reveals the following: Regarding " Staff mismanaged residents' medication", it is alleged that the facility mismanaged C1 and C2 medications. According to staff interviewed, C1 was using two (2) physicians with two (2) different pharmacy which led to a miscommunication with C1’s medication. C1’s Ambien was changed from a medication only being given as needed to a medication given routinely. The facility did not give the medication routinely due to either misplacing the medication or facility MAR’s not being updated. LPA reviewed the MARs for C1 and observed it not being written as a routine medication and still being considered as a PRN. LPA also observed there was no indication at C1’s Ambien was given the whole month of May. LPA observed C2’s MAR’s and observed that C2’s Clozaril was not given 5/5/204- 5/10/24. During medication review LPA observed missing medications or missing initials on medications that was given.

The investigation reveals the following: Regarding " Staff did not refill residents’ medication prescription in a timely manner.", it is alleged that C2 did not get a refill on Clozaril, a routine bedtime medication. The investigation reveals that night staff did not inform AM staff that C2’s medication needed a refill. When the facility tried to refill C2’s medication, the information was sent to the wrong pharmacy.

Based on LPA observation, interviews and file review, the preponderance of evidence standard has been met, therefore, the above allegations is found to be SUBSTANTIATED. California Code of Regulation, Title 22 are being cited on the attached LIC9099D.



Exit interview conducted with Administrator Gill Martinez and LVN Zean Montana. A copy of this record provided, and appeals rights given.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240513113813
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: FOUNDERS HOUSE OF HOPE
FACILITY NUMBER: 191592599
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/17/2024
Section Cited
CCR
80075(b)(5)(B)
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80075 Health Related Services
(B) Once ordered by the physcian the medication is given according to the physcian's directions.

This requirement was not met as evidence by:
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The facility will ensure all staff members are
sign off on the MAR's, and give the medications as perscribed. The facility will also enact a proper procedure when a client is going to run out of medications.
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Based on observation, interviews conducted
and file review it was revealed C1 and C2 was not recieving medications as perscribed and is missing medications, which poses an immediate health, safety, or personal rights risk to persons in care.
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1) The licensee will submit a plan of action on
how they will limit medication errors and provide medication training to staff by POC due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3