197602038-8-2-2022-31-AS-NMAN-CH4SQJ-20220808140450

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602038
Report Date: 08/02/2022
Date Signed: 08/02/2022 02:53:06 PM

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
03/01/2022 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20220301141721

FACILITY NAME:	FLOWERS RESIDENTIAL CARE FACILITY		FACILITY NUMBER:	197602038
ADMINISTRATOR:	SARAH KIRK		FACILITY TYPE:	740
ADDRESS:	2762 VISSCHER PLACE		TELEPHONE:	(626) 797-7996
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	6	CENSUS: 5	DATE:	08/02/2022
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Roderick Kirk, Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident was found covered in feces while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit to deliver the finding for the above noted allegation. LPA met with Administrator Roderick Kirk and explained the reason for the visit.

It was reported that a resident was found covered in feces while in care. To investigate this allegation, on 3/09/2022 between 1:01pm and 2:10pm staff interviews were initiated. Interviews revealed that during the daily morning routine of incontinent care that Resident #1 (R1) was found unresponsive. Staff immediately notified the administrator and 911 was called. Before paramedics arrived, R1 had a bowel movement. The staff did not have time to finish providing incontinent care, since EMTs arrived immediately and took R1 to the hospital. On 7/28/2022 at 11:12 am, LPA conducted records review. Records reviewed revealed that R1 did arrive to the hospital covered in feces, but it did not indicate if the feces found on R1 were fresh or old. No pictures were taken, and a detailed description was not provided as well.
Based on interviews and records review, there is not sufficient information to verify this allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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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