191600341-9-20-2023-11-AS-MVAO-CVWQXP-20230922123351

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600341
Report Date: 09/13/2023
Date Signed: 09/20/2023 04:16:40 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/13/2022 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220913161318

FACILITY NAME:	HUNTINGTON RETIREMENT HOTEL		FACILITY NUMBER:	191600341
ADMINISTRATOR:	HEATHER ARGUETA		FACILITY TYPE:	740
ADDRESS:	20920 EARL STREET		TELEPHONE:	(310) 370-5828
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	155	CENSUS: 105	DATE:	09/13/2023
		UNANNOUNCED	TIME BEGAN:	04:38 PM
MET WITH:	Corina Kahl/Coordinator		TIME COMPLETED:	04:39 PM

ALLEGATION(S):

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Due to staff neglect resident developed a pressure injury while in care.

INVESTIGATION FINDINGS:

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This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created on 9/13/2023.
On 9/13/2023 Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced complaint visit to this facility to conclude the agency’s investigation. LPA met with Corina Kahl/Coordinator and explained the purpose of today’s visit is to deliver findings for the allegations listed above. LPA was granted access to the facility grounds.

The investigation consisted of the following: On 9/14/2022 LPA Lourdes Montoya conducted a tour of the facility grounds and requested the following records for three residents' (R1-R3): Admission Agreement, Physician’s Report, Appraisal/Needs and Services Plan, Hospital/Clinic Visits Summary Reports, Incident Reports, Home Heath notes, and Hospice Notes. LPA obtained Staff roster, Resident roster, and other pertinent documents associated with this complaint. The complaint was referred the Department of Social Services Investigation Branch and was assigned to Investigator (IB) Peter Zetruche. Investigator Zetruche conducted record reviews, a review of medical records and conducted staff, resident, and witness interviews. Additional interviews were completed with Staff 1-Staff 5 (S1-S5), W1 and an interview was attempted with staff 6(S6)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Benita Yates	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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 11-AS-20220913161318

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HUNTINGTON RETIREMENT HOTEL	FACILITY NUMBER: 191600341
	VISIT DATE: 09/13/2023

NARRATIVE

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The investigation revealed the following:
Allegation: Due to staff neglect resident developed a pressure injury while in care.

It is alleged that resident 1 (R1) developed a pressure injury while in care of the facility due to the staff’s neglect. R1 was admitted to the facility on 9/11/2021. A review of her service assessment form, completed on 9/04/2021 shows resident was independent in mobility and activities of daily living. After R1’s 3/22/2022 hospitalization, records show that R1 was admitted to St. Liz Hospice Care on 4/8/2022. R1’s initial hospice assessment noted that R1 had poor skin turgor and her skin was easily prone to bruising and tearing. It was also noted that due to R1’s limited mobility she was a high risk for skin breakdown and that primary caregivers were instructed to turn and reposition R1 every 2 hours and to provide adequate skin care. As of 4/8/2022 there was a physician’s order by the hospice for skin care maintenance to R1’s buttocks area to prevent skin breakdown and redness. A review of facility records shows that on 5/10/2022 an open sore was seen on R1’s buttocks and both hospice and family were informed. Per W1, R1 was diagnosed with a stage 2 pressure ulcer to the sacral coccyx area on 5/12/2022, which W1 described as redness. LPM Cifuentes interviewed Staff S1-S5 and attempted to interview S6. S6 was no longer employed by the facility and could not be contacted for an interview. LPM asked staff if resident was repositioned every two hours as stipulated in the hospice care plan. Of those interviewed, 5 out of 5 answered yes. LPM also asked staff who handled R1's wound care, and 5 out of 5 staff inteviewed stated the facility does not handle wound care, that only a nurse can do that. S1 added during their interview that hospice nurses handled the wound care for R1 and that R1 had an alternating pressure mattress. S2 stated during the interview that the facility does not keep logs regarding the repositioning of residents. LPM noted that notes from St. Liz Hospice account for the wound care provided to R1 by hospice nursing staff

Based on interviews, observation, information received, and records reviewed there was not enough evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated.

There were no deficiencies cited. Exit interview conducted with Corina Kahl and redelivered to Heather Argueta.

SUPERVISOR'S NAME: Benita Yates	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC9099 (FAS) - (06/04)

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