197602038-7-20-2022-31-AS-NMAN-CHBL45-20220815082457

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602038
Report Date: 07/20/2022
Date Signed: 07/20/2022 01:57:20 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, 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
02/23/2022 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20220223161449

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:	07/20/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Roderick Kirk, Administrator		TIME COMPLETED:	01:28 PM

ALLEGATION(S):

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Resident developed multiple pressure injuries while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted a subsequent complaint visit to deliver the findings for the above noted allegation. LPA met with Roderick Kirk, Administrator. The purpose of the visit was discussed. The investigation of the above noted allegation was conducted by Investigator Dennis Douglas from the Community Care Licensing Division Investigations Branch (CCLDIB).

Allegation-Resident developed multiple pressure injuries while in care.

It was alleged that facility resident #1 (R1) was admitted to the hospital and was observed to have multiple pressure injuries "stage III" and "unstageable."

To investigate this allegation, the investigator spoke with the facility staff on 3/16/2022 and Home Health Staff on 3/16/2022. In addition, the investigator reviewed R1's medical records on 7/08/2022.
Continue on 9099C

Substantiated

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: 07/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022

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 31-AS-20220223161449

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: FLOWERS RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 197602038
	VISIT DATE: 07/20/2022

NARRATIVE

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Interviews revealed that R1 began their residency at the facility on 2/10/2022. R1 was admitted to the facility with unstageable pressure injuries on their heels. R1 was 100% bed bound, and as a part of their care plan, R1 needed to be turned and repositioned in bed, but due to the resident's refusal, R1 was not turned and repositioned in bed as required.

In addition, interviews revealed that home health services were initiated at the time of admission and continued until (2/16/2022) at which time R1 was being treated for pressure injuries. Home health nurse reported to the investigator that R1 had "unstageable" pressure injuries on both of their heels at the time of their arrival to the facility and facility staff did not observe or were aware of any other pressure injuries that R1 had.

Furthermore, a review of the hospital medical records revealed that R1 was transported to the hospital from the assisted living on 2/21/22, primarily due to unresponsiveness. Per medical report obtained by the investigator, it was noted that at the time of admission R1 was indeed discovered with multiple pressure injuries that were deemed "stage III" and "unstageable" not only on R1's heels, but also on their back and on the buttock area.
The wounds on R1's back and buttock area were noted as "dark", "black", and "purple" in color with "necrotic tissue." Per home heath records review, there was no indication that they were treating any additional wounds on R1 other than the pressure injuries on both heels. Based on the interviews and record review it was concluded that R1 was admitted to the facility with unstageable pressure injuries. Since R1 was not turned and repositioned while in bed, it is more likely than not, that R1 sustained additional unstageable pressure injuries during their residency at the facility due to neglect in care and supervision.

The information revealed during this investigation corroborates with the information reported by the complainant. Hence, this allegation is SUBSTANTIATED at this time.

During the investigation, LPA Valenzuela and Investigator Douglas noted other deficiencies unrelated to the complaint. Therefore, a Case Management visit was conducted to address all noted deficiencies.

At the time of this visit the Administrator was notified that an immediate $500.00 civil penalty will be assessed to the facility due to neglect in care and supervision which poses and immediate health and safety risk to residents in care. In addition, the Administrator was informed that upon further analysis conducted by the department, an additional civil penalty might be assessed, based on Health and Safety Code 1548.
Exit interview was conducted, appeal rights were discussed, and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220223161449

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: FLOWERS RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 197602038
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/20/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/26/2022 Section Cited CCR 87615(a)(1)	1 2 3 4 5 6 7	87615(a)(1)-Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to those specified below shall not be admitted or retained in a residential care facility for the elderly. (1) Stage 3 or 4 pressure injuries. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Licensee will submit in writing to CCLD how they will ensure that the facility will no longer accept residents with prohibited health conditions by 7/26/2022.
	8 9 10 11 12 13 14	Based on interviews and record review the Licensee accepted a resident who had stage III pressure injuries on both heels. The pressure injuries were deemed by health professionals to be unstageable. This poses an immediate health and safety risk to risidents in care.	8 9 10 11 12 13 14
Type A 07/26/2022 Section Cited CCR 87464(d)	1 2 3 4 5 6 7	87464(d) Basic Services- (d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in section 87457... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Licensee will submit in writing to CCLD, how they will ensure that all residents basic services are being met as stated on their pre-admission appraisals.
	8 9 10 11 12 13 14	Based on interviews and record review the Licensee did not ensure that the resident's needs as identified in their pre-admission appraisal were met by facility staff. This poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

LIC9099 (FAS) - (06/04)

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