197610032-3-9-2022-31-AS-CHAS-CCYSB5-20220329134321

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 03/09/2022
Date Signed: 03/09/2022 05:55:46 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
03/01/2022 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20220301144719

FACILITY NAME:	LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY		FACILITY NUMBER:	197610032
ADMINISTRATOR:	JESSICA PELAYA		FACILITY TYPE:	740
ADDRESS:	44523 15TH STREET WEST		TELEPHONE:	(661) 941-4578
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	157	CENSUS: 108	DATE:	03/09/2022
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Staff lacks knowledge of the appropriate infectious disease prevention measures.
Resident's medication was left in a disposable cup within resident's room

INVESTIGATION FINDINGS:

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LPA Spaeth made an unannounced visit to the facility and observed the COVID signs on the front door. LPA's temperature was taken and recorded. LPA explained the purpose of the visit was to present LPA's findings. The allegations are: staff lacks knowledge of the appropriate infectious disease prevention measures; and Resident's medication was left in a disposable cup within resident's room

LPA interviewed caregiver from 2:00 pm until 2:20 pm via phone call. LPA also interviewed resident from 4:00 pm until 4:10 pm and interviewed Administrator from 4:15 pm until 4:30 pm.

Staff lacks knowledge of the appropriate infectious disease prevention measures. Based upon LPA's interview with caregivers, and based upon LPA's interviews of Los Angeles County Department of Health LVN

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

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-20220301144719

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: LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY	FACILITY NUMBER: 197610032
	VISIT DATE: 03/09/2022

NARRATIVE

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staff, on March 1, 2022, a Los Angeles County Department of Health LVN witnessed a caregiver did not change gloves after disposing of the soiled incontinent briefs . Also, a caregiver did not wear appropriate PPE when managing incontinence care of residents with diarrheal illness. LPA Spaeth interviewed the caregiver today at 2:00 pm who was assisting the resident mentioned within the complaint who stated did not know to wear additional PPE when caring for a resident with diarrheal illness. Also, LPA interviewed the med tech who stated there were three additional residents who experienced diarrheal illness on that day. Due to this evidence, The Los Angeles County Department of Public Health LVNs who visited the facility were told this information and therefore the facility would need to follow the infectious disease control guidelines.

Also, the reporting party was made aware by clinic staff that during the LVN's visit, a disposable cup with medication was sitting out in the resident's room. Reporting Party was made aware by clinic staff that during DOT visit, staff saw a disposable cup with medication was sitting on a table in R1's room. A photo was taken by the LVN during the visit.

Therefore the allegations stating staff lacks knowledge of the appropriate infectious disease prevention measures and resident's medication was left in a disposable cup within resident's room are substantiated. Pursuant to Title 22 Division 6 of the CA Code of Regulations, a deficiency was cited (refer to LIC 809-D).

Exit interview conducted, Appeal Rights discussed, and a copy of the report was issues to Administrator.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220301144719

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: LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY	FACILITY NUMBER: 197610032
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/09/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/18/2022 Section Cited CCR 87465(h)2	1 2 3 4 5 6 7	Incidental Medical and Dental Care Services. Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator will conduct proper training regarding medication distribution to ensure this incident will not occur again.
	8 9 10 11 12 13 14	Los Angeles County Department of Health LVN professionals witnessed the medication was left out and accessible to anyone who walked into the room. Facility staff did not insure the medication was properly taken by a resident to which is an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
Type B 03/18/2022 Section Cited CCR 87470(2)	1 2 3 4 5 6 7	All staff and volunteers providing direct care to a resident who has a communicable disease shall wear appropriate Personal Protective Equipment (PPE) to prevent exposure to infectious agents... PPE may include gloves, gowns, masks, etc. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator will review Regulation 87470 Infection Control Requirements with all staff.
	8 9 10 11 12 13 14	Los Angeles County Dept. of Health LVN professionals witnessed caregiver did not wear full PPE.	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: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC9099 (FAS) - (06/04)

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