197606651-7-16-2021-28-AS-CYEE-C79MWZ-20210927095911

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606651
Report Date: 07/16/2021
Date Signed: 07/16/2021 02:37:50 PM

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
06/24/2021 and conducted by Evaluator LaJean Nicole Spencer

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210624121412

FACILITY NAME:	LAKEWOOD GARDENS		FACILITY NUMBER:	197606651
ADMINISTRATOR:	SHOLOM YOSEF GOLDMAN		FACILITY TYPE:	740
ADDRESS:	12055 S. LAKEWOOD BLVD.		TELEPHONE:	(562) 869-4038
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	150	CENSUS: 67	DATE:	07/16/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Joe Goldman, administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident contracted scabies while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs) Nicole Spencer and Alberto Lopez conducted a subsequent visit to deliver the findings for the allegation listed above. LPAs were met by administrator Joe Goldman and explained the purpose of today’s visit.

The investigation consisted of the following: On 6/29/21, LPA Spencer interviewed the assistant administrator, staff #1 (S1), residents #1-6 (R1-R6), R1's power of attorney (F1), and R1's physician's assistant dermatologist (PA). R4 was unable to answer questions so interview was discontinued. During the course of the investigation, LPA interviewed staff #2 (S2) and obtained copies of the staff roster, resident roster, and R1's hospital discharge papers, doctor’s visit notes, biopsy report, MAR log, physician’s order, caregiver body check assessment, and incident report.

***See LIC9099C for continuation of this narrative.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021

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 28-AS-20210624121412

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: LAKEWOOD GARDENS	FACILITY NUMBER: 197606651
	VISIT DATE: 07/16/2021

NARRATIVE

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Regarding the allegation: resident contracted scabies while in care, incident report stated that R1 was sent to hospital on 6/23/21 for generalized weakness and skin rash. Hospital discharge papers stated that the problem areas were scabies, rash, and anemia. The assistant administrator stated that R1 had suspected scabies but was seen by a dermatologist and was not diagnosed with scabies. All staff interviewed denied that any resident had scabies. Three (3) out of five (5) residents stated that they were not aware of any residents with itching or redness. F1 said that R1 does not have a history of scabies and verified with the dermatologist that R1 does not have scabies. The dermatologist (PA) stated that R1 had gone through two precautionary treatments for scabies that R1 didn’t respond to which caused them to rule out scabies and is more consistent with an allergy to medication.

A review of the records revealed that the doctor’s visit notes from 5/25/21 say that R1 gets frequent rashes and was referred to a dermatologist. Based on dermatologist visit notes, R1 was seen by the dermatologist on 6/12/21, 6/14/21, and 6/22/21 and underwent a patch allergy test and biopsy to determine the cause of the rash. Per biopsy report dated 7/7/21, the formal diagnosis was dermatitis unspecified and allergic reaction. MAR logs showed that R1 is not currently being treated with Elemite (Permethrin) cream which is used to treat scabies.

Based upon interviews and records reviewed, the findings indicate that 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 Unsubstantiated.

An exit interview was conducted with administrator and a copy of the report was provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021

LIC9099 (FAS) - (06/04)

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