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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609011
Report Date: 02/12/2024
Date Signed: 02/12/2024 05:14:58 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
01/03/2024 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20240103165416
FACILITY NAME:STRAWBERRY COTTAGEFACILITY NUMBER:
197609011
ADMINISTRATOR:TAYLOR, DAVID JAMESFACILITY TYPE:
740
ADDRESS:43732 SENTRY LANETELEPHONE:
(661) 266-7995
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 6DATE:
02/12/2024
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:TIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff mishandling residents medication.
Staff not maintaining a comfortable room temperature for resident.
Staff does not provide resident grab bars for safe showering.
Call button not accessible to resident.
INVESTIGATION FINDINGS:
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On 02/12/2024 Licensing Program Analysts (LPA) Evelin Rios arrived at the facility to conduct an unannounced subsequent visit to deliver the determination on the above allegations. LPA was greeted by Staff #1 (S1) who granted access. S1 contacted the administrator David Taylor and administrator designee Monica Gory to let them know LPA was at the facility. Administrator and administrator designee met LPA shortly after. LPA explained the purpose of the visit.

At 1:00 p.m. LPA conducted a physical plant tour to ensure the health and safety of the residents in care.

Allegation #1: Staff mishandling resident medication. It was alleged staff have given resident #1 (R1) an incorrect dosage of medication on different occasions. To investigate the allegation LPA Rios conducted an initial visit on 01/12/2024, during this visit LPA interviewed residents and staff from approximately 11:50 a.m. to 3:00 p.m. LPA also reviewed six (6) of six (6) Centrally Stored Medication and Destruction Records (CSMDR) and Medication Administration Records (MAR). (Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024
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 4
Control Number 31-AS-20240103165416
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: STRAWBERRY COTTAGE
FACILITY NUMBER: 197609011
VISIT DATE: 02/12/2024
NARRATIVE
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Records revealed Mirtazapine 45 mg has been provided to R1 in the morning at approximately 8:00 a.m. even though medication label reads “evening”. According to Ricky De Sahagun administrator designee on 01/12/24 he gave medication at a different time because R1 had requested multiple times to give them the medication in the morning, Ricky complied so as not to upset R1. LPA interview with Eugenia (Gina) Galindo who signed the report on 01/12/24 revealed they followed the medication label and provided medication to R1 as directed although R1 was upset about it. LPA review of MAR for days in question revealed R1 was provided medication Mirtazapine in the morning. Based on medication records, interviews and observation although medication was not provided on directed time, there is not enough evidence, the wrong dosage was given to R1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Allegation #2: Staff not maintaining a comfortable room temperature for resident. It is alleged the temperature in resident’s #1 (R1’s) bedroom is uncomfortable at 68 degrees Fahrenheit. To investigate the allegation LPA observed the thermostat in the house on 01/12/24, the temperature read 73 degrees Fahrenheit. On today’s visit the thermostat read 71 degrees Fahrenheit. On 01/12/24 LPA interviewed three (3) out of six (6) residents. Interview with R1 revealed they felt their room was cold and the licensee would direct staff to turn off the heater, however the temperature was fine during interview. During the interview LPA observed R1 wearing a shirt without sleeves. Interview with two (2) residents able to communicate with LPA revealed the temperature in their room and in the facility feels comfortable and may get warm. Furthermore, resident #2 (R2) stated they turn on their ceiling fan and close the vents when it becomes too warm. They do not mind the temperature because they know R1 feels cold. Interviews with three (3) staff denied the allegation. According to Ricky he believes the resident’s medication may be the reason the R1 may feel cold at times. Based on the temperature on the thermostat, interviews with staff and residents, the allegation is deemed UNSUBSTANTIATED at this time.

Allegation #3: Staff does not provide resident grab bars for safe showering. It is alleged resident #1 (R1) lost their balance and fell getting into the shower due to no grab bars to hold onto. To investigate the allegation LPA reviewed previous complaint control #31-AS-20230908152350. Facility had a grab bar and added a second grab bar entering the shower due to previous allegation in complaint. According to the licensee they got R1’s feedback on placement of grab bar added. Based on observation this allegation is deemed UNSUBSTANTIATED at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20240103165416
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: STRAWBERRY COTTAGE
FACILITY NUMBER: 197609011
VISIT DATE: 02/12/2024
NARRATIVE
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Allegation #4: Call button not accessible to resident. It is alleged resident #1 (R1) had requested a call button be installed in the bathroom for assistance. To investigate the allegation LPA reviewed facility requirements for a capacity of 6. According to staff they check on residents routinely depending on needs and services and as needed. For residents requiring further assistance they have been provided pendants they can wear or keep at reach to call for assistance. Resident #1 (R1) has a pendant they can take with them through out the facility. On 01/12/24 LPA tested R1's pendant and the receiver made a load sound heard though out the facility. Based on the information provided through interviews and observations made this allegation is deemed UNSUBSTANITATED at this time.

Due to time constraints LPA was unable to address issues observed during physical plant tour. LPA informed administrator an unannounced case management visit will be made to address issues and concerns observed.


Exit interview conducted. Copy of report provided
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4