197610032-7-13-2022-31-AS-CHAS-CHFQEA-20220819120601

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 07/07/2022
Date Signed: 07/13/2022 11:29:23 AM

Unsubstantiated

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
09/28/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20210928113222

FACILITY NAME:	LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY		FACILITY NUMBER:	197610032
ADMINISTRATOR:	LABELLA, MARK J		FACILITY TYPE:	740
ADDRESS:	44523 15TH STREET WEST		TELEPHONE:	(661) 941-4578
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	157	CENSUS: 108	DATE:	07/07/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Resident sustained severe pressure injuries while in care
Resident sustained multiple bruises while in care

INVESTIGATION FINDINGS:

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LPA Spaeth conducted an unannounced visit regarding the complaint. Upon arrival, LPA's temperature was recorded and COVID questions were completed. LPA explained the purpose of the visit was to present the findings regarding the allegations, resident sustained severe pressure injuries while in care and resident sustained multiple bruises while in care.

A complaint was received on September 28, 2021 which alleged Resident #1 (R1) sustained severe pressure injuries while in care and that R1 sustained multiple bruises while in care. The complaint investigation was conducted by Investigations Branch (IB) Investigator Wilfredo Vasquez. The complaint stated that R1 sustained several pressure injuries and multiple bruises while in care. The Reporting Party (RP) stated R1 had been hospitalized for a bladder infection and bed sores; however, sores on R1’ hip and buttocks were ninety percent (90%) necrotic and required a plastic surgeon consultation. Also, RP stated R1 had bruises on their arms which were leaking fluid.

Unsubstantiated

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: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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-20210928113222

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: 07/07/2022

NARRATIVE

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Facility documentation indicated redness was on R1’s buttock area on July 27, 2021. On July 29, 2021, Administrator Jessica Pelaya contacted health care hub requesting home health due to R1’s wounds. A home health order was written on August 2, 2021. Administrator described the wound as a nickel sized area of redness on R1’s buttocks and Administrator instructed caregivers to turn R1 every two hours.
On August 6, 2021, R1 had been seen by Dr. Filart at the facility. Doctor reported swelling on the left lower leg. Dr. Filart stated he did see a bedsore on R1’s buttocks but did not document the stage of the bed sore.

During the triage process, there was no mention of any pressure injuries but R1 was admitted to hospital due to other medical complications. R1 was seen by a Nurse Practitioner (NP) and a Doctor who both reported seeing a sacral pressure injury on R1’s buttocks. NP stated the wound was large and unstageable on the sacrum with purulent discharge. The Doctor stated the progression of most pressure injuries takes a couple of days to get to the state which was seen on August 9, 2021; however, it also depended on the health of the patient.

Caregivers that were interviewed by Investigator Vasquez did report that they only saw redness on buttocks but no broken skin. The Administrator stated that R1’s skin was not open when R1 left for the hospital and the wound did not progress beyond redness. R1 was sent to the hospital (non-emergency) on August 8, 2021.

The triage Doctor stated since R1 was very sick the wound could have rapidly progressed based upon moisture and friction. R1 was transported from the facility to the hospital on August 8, 2021 and the distance was sixty-four miles. The condition of the wounds as evidenced in the hospital discharge summary on 8/21/2021 was consistent with the allegation. However, R1 had not been at the facility since August 8, 2021. In regard to the allegation, resident sustained multiple bruises while in care is also unsubstantiated. Upon reviewing the hospital medical records, there were no reports of multiple bruises on R1’s body

Based on the information collected during this investigation, there is not sufficient evidence to substantiate the allegations. Therefore, the allegations are deemed unsubstantiated at this time. Exit interview was conducted, a copy of the report was issued, and appeal rights were discussed.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

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