197607628-7-13-2023-28-AS-RORN-D8BQRZ-20240820122446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607628
Report Date: 07/13/2023
Date Signed: 07/13/2023 06:12:18 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, 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
07/03/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20230703110346

FACILITY NAME:	PILGRIM PLACE IN CLAREMONT		FACILITY NUMBER:	197607628
ADMINISTRATOR:	RICHARD RODAS		FACILITY TYPE:	741
ADDRESS:	625 MAYFLOWER ROAD		TELEPHONE:	(909) 399-5500
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	454	CENSUS: 50	DATE:	07/13/2023
		UNANNOUNCED	TIME BEGAN:	08:05 AM
MET WITH:	Dawnyell Varela, Director of assisted living		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff neglect led to resident suffering from multiple UTIs
Staff did not seek medical attention for resident in a timely manner
Staff did not ensure that resident's catheter needs were met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced initial complaint visit to the facility regarding the above-mentioned allegations. Upon arrival, LPA met Dawnyell, director and explained the purpose of today’s visit.

The investigation consisted of interviews of staff from Staff #1 (S1) through Staff #4 (S4); interviews of residents from resident#2 (R2) through resident #6 (R6); attempted to interview resident #1 (R1); reviews of resident#1 (R1)’s record; and tour of the facility. LPA obtained copies of the staff and resident rosters, and resident #1 (R1)’s records with relevant information.

The investigation revealed the following:

Regarding the allegation “staff neglect led to resident suffering from multiple UTIs,” it was alleged that resident#1 (R1) had recurrent UTIs in a few weeks due to staff’s negligence. (- continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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 28-AS-20230703110346

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: PILGRIM PLACE IN CLAREMONT	FACILITY NUMBER: 197607628
	VISIT DATE: 07/13/2023

NARRATIVE

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LPA Tao attempted to interview resident#1 but all attempts failed. Five (5) out of six (6) residents interviewed could not corroborate the allegation. Resident reviews revealed that staff was not being negligent taking care of residents who has/had UTIs. Four (4) staff interviewed denied the allegation. LPA reviewed R1’s facility record revealed that R1 had UTIs due to having catheter for years and staff had been monitoring resident closely. Therefore, resident who has recurrent UTIs was not due to staff negligent.

Regarding the allegation “staff did not seek medical attention for resident in a timely manner,” it was alleged that staff did not send resident#1 (R1) to hospital for medical treatment on a timely basis. LPA attempted to interview resident#1 but all attempts failed. Five (5) out of six (6) residents interviewed could not corroborate the allegation. It revealed that residents received medical treatments as needed on a timely basis. Four (4) staff interviewed denied the allegation. LPA reviewed R1’s facility record revealed that staff had monitored R1’s medical needs closely and provided medical care timely. Therefore, facility staff did not fail to seek medical attention for resident in a timely manner.

Regarding the allegation “staff did not ensure that resident's catheter needs were met,” it was alleged that staff failed to change resident#1’s catheter bag nightly. LPA attempted to interview resident#1 but all attempts failed. Five (5) out of six (6) residents interviewed could not corroborate the allegation. Four (4) staff interviewed denied the allegation. LPA reviewed R1’s facility record revealed facility staff was not allowed to change catheter tube and bag because facility is not a skilled nursing facility. Resident’s catheter bag needed to be changed in the hospital. Therefore, staff had met resident's catheter needs while in care.

Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Administrator and findings were discussed. A copy this report was provided to Administrator at time of visit.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC9099 (FAS) - (06/04)

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