197609007-6-16-2021-28-AS-MVAO-C5KR5M-20210804124323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609007
Report Date: 06/16/2021
Date Signed: 06/16/2021 01:04:55 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
03/18/2021 and conducted by Evaluator LaJean Nicole Spencer

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210318101925

FACILITY NAME:	GLENDALE GARDEN CARE HOME		FACILITY NUMBER:	197609007
ADMINISTRATOR:	DEANON, IRENE		FACILITY TYPE:	740
ADDRESS:	405 CHESTER STREET		TELEPHONE:	(818) 640-2912
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91203
CAPACITY:	6	CENSUS: 5	DATE:	06/16/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Romina DSouza		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident developed stage 1 pressure injury while in care.
Staff did not provide adequate care for resident.
Staff used profanity towards resident.
Resident's responsible party was not informed about resident's change in condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Spencer conducted a subsequent visit to deliver the findings for the allegations listed above. LPA Spencer was met with assistant administrator Romina DSouza and explained the purpose of today's visit.

The investigation consisted of the following: On 3/24/21, LPA Spencer conducted telephonic interviews with administrator Irene Deanon and staff #1-3. LPA Spencer received a copy of the staff roster, resident roster, admissions agreement, and for 3 specified residents: face sheet, needs & services/care plan, caregivers notes, and hospital discharge papers for resident#1 (R1) on 3/10/21. LPA interviewed reporting party (RP) and received photos of R1, hospital discharge papers from visit on 3/10/21, physician's notes from 3/10/21, police report from visit on 3/10/21, and letters of support/concern. LPA interviewed family members (F1-F2). On 6/16/21, LPA interviewed residents 2-6 (R2-R6) and reviewed R1's file. R1 could not be interviewed because she passed away, and R2 and R6 could not be interviewed because they were asleep.
***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: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

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-20210318101925

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: GLENDALE GARDEN CARE HOME	FACILITY NUMBER: 197609007
	VISIT DATE: 06/16/2021

NARRATIVE

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The investigation revealed the following:
Resident developed stage 1 pressure injury while in care. It was alleged that R1 developed a stage 1 pressure injury as a result of neglect while in care. A review of the photos of R1 (date unknown) shows red discoloration on the right buttocks and arm. The physician's notes from visit on 3/10/21 state that RP had concerns over pressure injuries. Physician's notes state that R1 appears clean, well-nourished, with no signs or symptoms of neglect or abuse. During interviews, the administrator and S2-S3 denied that R1 developed a pressure injury but stated that there was red discoloration on R1's skin. S1 stated that R1 developed pressure injury on and off for the past year but it was mostly redness on the skin. S1 stated that she contacted R1's responsible party and physician regarding the issue and that R1's physician ordered that the resident is re-positioned and changed every 2 hours. F1 stated that R1 had a very mild pressure injury in early stages on the sacrum area but that staff treated it right away. F2 stated that he was unsure if R1 developed any pressure injuries. Residents interviewed had no knowledge of resident who had pressure injury. A review of R1's care plan shows that R1 is prone to skin discoloration and bed sores and the treatment plan included frequent diaper changes, cleansing of skin, and application of lotions. There was no indication on hospital discharge papers from 3/10/21 that R1 had a current pressure injury.
Staff did not provide adequate care for resident. It was alleged that there was not enough staff to provide proper care and assistance to residents. The administrator and staff stated that they serve dementia residents who each have a dementia care plan. LPA observed that the facility had a dementia care plan on file for residents. Staff stated that there are two staff per shift and 1 staff overnight. S1-S2 said that all residents are bathed/showered 3 times per week and changed 3-5 times per day. Concerning R1, staff stated that she had a history of scratching, which was treated with frequent diaper changes and lotions/ointment. F2-F3 stated that R1 received excellent care at the facility and had no concerns. Residents interviewed that they like it at the facility and there are enough staff to care for them. A review of the hospital discharge papers from 3/10/21 show that there were no indications of abuse or neglect.
Staff used profanity towards resident. It was alleged that a staff member (unknown) cursed at R1 after she spit towards the staff. Administrator and staff denied knowledge about this incident and stated that staff always speak respectfully to residents. F1 stated that this incident happens 3 years ago and that the family talked to staff regarding the concern and it has not happened again, while F2 does not recall details of this incident. Residents interviewed stating that staff treat them well and speak to them respectfully.
***See LIC9099C for continuation of this narrative.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20210318101925

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: GLENDALE GARDEN CARE HOME	FACILITY NUMBER: 197609007
	VISIT DATE: 06/16/2021

NARRATIVE

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Resident's responsible party was not informed about resident's change in condition. It was alleged that the facility did not inform R1's RP regarding a change/decline in condition. LPA reviewed the records R1's care plan shows that R1 had Alzheimer's and that physical health was declining to due advanced age. The care plan stated that R1 was prone to bed sores, agitation, unsteady gait, and was at high risk for falls. Changes in condition were also documented on caregiver notes. During interviews, the administrator and staff stated that if there is a change in condition, the responsible party is notified right away. A review of R1's face sheet shows that the emergency contact listed is F2, while the health care agent form on file lists both RP and F2 as the emergency contact person. The administrator and S1 stated that they informed both RP and F2 regarding any changes in R1's condition and that that F2 is listed as primary contact. S2-S3 stated that only F2 was notified since he is listed as the responsible party. F1 and F2 stated that F2 became the primary contact in March 2021 and said that the facility frequently kept him up-to-date with R1's health and communicated with him almost daily.

Based on interviews and record reviews, the findings indicate although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are Unsubstantiated.

An exit interview was conducted with Romina DSouza and a hard 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: 06/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

LIC9099 (FAS) - (06/04)

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