197609853-9-23-2021-31-AS-NMAN-C7QV8V-20211012161322

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609853
Report Date: 08/05/2021
Date Signed: 09/23/2021 03:58:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/20/2021 and conducted by Evaluator LaQueena Lacy

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20210720125321

FACILITY NAME:	REESEJOY CARE HOME II		FACILITY NUMBER:	197609853
ADMINISTRATOR:	RAMIREZ, ROBERTO		FACILITY TYPE:	740
ADDRESS:	17544 SAN JOSE ST		TELEPHONE:	(805) 832-8792
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 4	DATE:	08/05/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Roberto Ramirez		TIME COMPLETED:	01:11 PM

ALLEGATION(S):

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9

Facility staff did not give resident medication because it was inconvenient.

INVESTIGATION FINDINGS:

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An unannounced subsequent complaint visit was conducted on 08/05/2021 at 9:33am by Licensing Program Analyst (LPA) LaQueena Lacy and Licensing Program Manager (LPM) Cassandra Harris. Upon arrival LPA and LPM met with Administrator Roberto Ramirez and explained the purpose of this visit.
It was alleged that R1 is not given pain medication when asks because staff told them it's "too much paperwork," To investigate this allegation on 07/27/2021 at 10:00am, LPAs gathered various facility records.
Based on record review and interviews R1 had requested pain medication which is a Pro Re Nata (PRN). On the date of 07/27/2021 at 10am a complaint visit was conducted and copies of pertinent documents relevant to the investigation was obtained. Based on review of the records conducted on 07/27/21 at 10am, centrally stored medication log dated 06/04/2021, identifies Norco as PRN medication. PRN log was completely blank without any logged entries. On 07/27/2021, at 11:35am, R1 was interviewed and stated that they have been in the facility since 06/04/21 and has not taken any pain medication. Facility staff interviewed on 07/27/2021 at approximatley 11:53am was unable to provide any credible explanation as to why R1’s PRN log was blank. Based on observations, record reviews and interviews there is sufficient information to verify the allegation. Therefore, the allegation is substantiated. Exit interview conducted. Copy of this report and appeal rights issued.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 586-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021

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 31-AS-20210720125321

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: REESEJOY CARE HOME II	FACILITY NUMBER: 197609853
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/05/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/15/2021 Section Cited CCR 87465(a)(5)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (a)A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (5)The licensee shall assist residents with self-administered medications as needed.	1 2 3 4 5 6 7	Licensee will provide additional medication training to all staff by appropriate professional(s). Proof of in-service training sign-in log will be submitted to LPA.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by. Based on interviews and record review, the staff did not dispensed PRN pain medication to R1. This possess an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Naira Margaryan	TELEPHONE: (818) 586-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021

LIC9099 (FAS) - (06/04)

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