197607820-12-16-2021-28-AS-MVAO-CCDSH6-20220310125302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607820
Report Date: 12/16/2021
Date Signed: 12/16/2021 05:17:34 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
12/10/2021 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211210121910

FACILITY NAME:	REGENCY PARK ASTORIA		FACILITY NUMBER:	197607820
ADMINISTRATOR:	ANNABELLE ARGENAL		FACILITY TYPE:	740
ADDRESS:	925 EAST VILLA STREET		TELEPHONE:	(626) 796-4303
CITY:	PASADENA	STATE: CA	ZIP CODE:	91106
CAPACITY:	220	CENSUS: 68	DATE:	12/16/2021
		UNANNOUNCED	TIME BEGAN:	01:17 PM
MET WITH:	Gina Lopez, Business Office Manager		TIME COMPLETED:	05:20 PM

ALLEGATION(S):

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Staff are not meeting resident's feeding needs.
Resident's pendent was not accessible to the resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted a subequent complaint visit to deliver findings on the above allegation. The purpose of the visit was discussed with Business Office Manager Gina Lopez. Assistant Administrator Brianna Goodlett was explained the purpose and interviewed telephonically.

The investigation consisted of the following: A physical plant tour of the Assisted Living floors and Memory Care Unit was conducted. Staff (S1- S5) and residents (R2- R9) were interviewed. An interview was attempted with resident (R1), but due to health condition it was not possible. Resident (R1's) file documents [Identification and Emergency Information, Preplacement Appraisal Information, Physician Report, Admission Agreement, Hospice Care Plan] Memo, resident roster, and staff roster.

See LIC 9099C for report continuation.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

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-20211210121910

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: REGENCY PARK ASTORIA	FACILITY NUMBER: 197607820
	VISIT DATE: 12/16/2021

NARRATIVE

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Allegation: "Staff are not meeting resident's feeding needs." Based on document review and interviews conducted the findings indicate that on December 9, 2021 resident (R1) was not provided feeding assistance during dinner time in a timely manner. The resident is receiving hospice services and is unable to feed its self. The resident typically gets the dinner tray delivered to the room at 4:30 pm. It is alleged that it was 6:15 PM and the resident had not received any feeding assistance. The resident requires total care. Staff stated that on December 9, 2021 the resident had a bowel movement prior to dinner time and was subsequently changed into pajama bottoms because after dinner time the resident is transferred back to the bed. Staff (S2)/caregiver stated that the resident refused to eat; therefore staff decided to return at a later time to try to feed the resident again. Per staff, there is a microwave in the room and food is reheated if it is cold.

According to staff interviews, hospice care instruction is to try to feed the resident as much food as possible, but the resident has been declining in health and it's appetite has decreased. Staff are instructed to return to a resident's room within 20-30 minutes after a resident refuses to eat. On the date aforementioned staff did not return within 20-30 minutes. They returned close to 2 hours later and the resident had not been fed. Document review revealed that resident (R1) requires total ADL assistance and has cognitive impairment. A total of eight (8) residents were interviewed, none reported their feeding needs are not met. However, per resident (R1's) Physician Report, Hospice Care Plan, and Appraisal Needs and Services Plan resident (R1) requires feeding assistance; which was not provided in a timely manner on December 9, 2021.

Allegation: "Resident's pendent was not accessible to the resident." Based on interviews conducted the findings indicate that on December 9, 2021 resident (R1) did not have an accessible pendant to call staff for assistance. All residents, with the exception of Memory Care Unit residents are provided a pendant necklace that calls for help. When resident (R1) was transferred from the bed to the wheelchair for dinner time the pendant was not given to the resident. The pendant was tied to the bed, inaccessible to the resident. Staff interviews revealed that the pendant was left by mistake on the resident's bed. Residents that were interviewed did not report any issues with pendant accessibility. But in regards to this allegation resident (R1) was not provided the pendant when it was transferred to the wheelchair. Resident (R1) does not reside in the Memory Care Unit; therefore is provided a pendant per admission agreement and care plan.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22.

An exit interview was conducted with Business Office Manager Gina Lopez. A copy of the report an appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20211210121910

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: REGENCY PARK ASTORIA	FACILITY NUMBER: 197607820
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/16/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/06/2022 Section Cited CCR 87468.2 (a)(4)	1 2 3 4 5 6 7	Additional Personal Rights of Residents in Privately Operated Facilities ....Shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met by evidence of:	1 2 3 4 5 6 7	Administrator is to submit a written plan of correction and ensure that Section 87468.2(a)(4) will be complied with at all times. Submit by POC due date.
	8 9 10 11 12 13 14	Based on interviews conducted on Dec. 9, 2021 resident (R1) was not fed dinner by staff in a timely manner. Resident requires total care and per hospice care plan staff shall assist with feeding. Staff stated R1 refused to eat at first, but staff failed to return in a timely manner to attempt to fed the resident. This poses a potential health and safety risk.	8 9 10 11 12 13 14
Type B 01/06/2022 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	Personnel Requirements - General. Facility personnel shall at all times be sufficient in numbers, ..... In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608. This requirement was not met by evidence of:	1 2 3 4 5 6 7	Administrator shall conduct staff in-service training addressing the staff protocols regarding call light pendants during transfers. Submit by POC due date.
	8 9 10 11 12 13 14	Based on interviews conducted the findings indicate that staff (S2) failed to give resident (R1) the call pendant after transferring the resident to the wheelchair. The pendant was left tied to the bed. This poses an potential health and safety risk.	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: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

LIC9099 (FAS) - (06/04)

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