197600297-5-9-2024-31-AS-NGID-D59KQ3-20240514080538

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197600297
Report Date: 05/06/2024
Date Signed: 05/09/2024 08:18:15 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/22/2021 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20211122143349

FACILITY NAME:	TRUDEZ HOME CARE		FACILITY NUMBER:	197600297
ADMINISTRATOR:	LOPEZ, VIRGILIO		FACILITY TYPE:	740
ADDRESS:	25821 OLIVAS PARK ROAD		TELEPHONE:	(661) 259-1827
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91355
CAPACITY:	5	CENSUS: 4	DATE:	05/06/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Eileen Calderon, Staff		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident's responsible party was not informed of a change in resident's care.
Facility mismanaged resident's medications.

INVESTIGATION FINDINGS:

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At 3:00pm, Licensing Program Analysts (LPAs) Angela Panushkina and Michael Cava conducted an unannounced subsequent visit to deliver final findings. LPAs met with the staff, Eileen Calderon, and explained the reason for the visit.

During the initial visit, conducted on 12/01/21, by LPA Panushkina interviews and records review were made. At 10:05am, LPAs requested resident and staff roster. At 10:10am, LPAs requested copies of pertinent information which include, but not limited to Physician’s Report, Centrally stored Medication and Destruction Records (CSMDR), relevant to the investigation. At approximately 10:15am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:20am – 12:00pm, LPA conducted an interviewed the Administrator and two (2) staff members.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

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 31-AS-20211122143349

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TRUDEZ HOME CARE	FACILITY NUMBER: 197600297
	VISIT DATE: 05/06/2024

NARRATIVE

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Resident's responsible party was not informed of a change in resident's care.

It was alleged that the R1’s responsible party was not informed that R1 was prescribed an antidepressant when placed to this facility. To investigate this allegation, LPA conducted an interview with the Administrator and two (2) staff members and was informed that the facility always follows doctor’s orders. In addition, two (2) staff members also informed LPA that R1 was not prescribed antidepressant upon admission and a copy of all prescribed medications were provided to R1’s responsible party. Moreover, LPA conducted review of R1’s Centrally stored Medication and Destruction Records (CSMDR) and did not observe R1 being prescribed with an antidepressant. Therefore, based on interviews and record reviews this allegation is deemed Unsubstantiated at this time.

Facility mismanaged resident's medications.

It was alleged that the facility received an order for R1’s doctor for a new prescription, Citalopram 10MG, and did not notify R1’s responsible party. To investigate this allegation, LPA conducted an interview with the Administrator and two (2) staff members, and all parties interviewed denied the above allegation. Two staff members interviewed denied ever receiving and or administering that medication to R1. Moreover, LPA conducted review of R1’s Centrally stored Medication and Destruction Records (CSMDR) and did not observe R1 being prescribed Citalopram upon admission nor thereafter. Therefore, based on interviews and record reviews this allegation is deemed Unsubstantiated at this time.

No Deficiency cited.

Exit interview conducted and copy of this report signed and issued.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

LIC9099 (FAS) - (06/04)

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