197610099-9-20-2023-31-AS-TAGD-CW9TB6-20231003143438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610099
Report Date: 09/20/2023
Date Signed: 09/20/2023 02:21:57 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
09/14/2021 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20210914112329

FACILITY NAME:	WYNGATE VILLA GARDENS		FACILITY NUMBER:	197610099
ADMINISTRATOR:	ESPINAL, ALMA		FACILITY TYPE:	740
ADDRESS:	7634 WYNGATE STREET		TELEPHONE:	(818) 352-4270
CITY:	TUJUNGA	STATE: CA	ZIP CODE:	91042
CAPACITY:	68	CENSUS: 52	DATE:	09/20/2023
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Oscar Chavez		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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1. Resident developed a pressure injury while in care
2. Resident's pressure injury developed maggots while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs) Tuesday Cabiness and Christopher Alemoh conducted a subsequent visit to deliver the final findings of the allegations mentioned above. LPA met with Administrator, Oscar Chavez and informed him the reason of the visit. The following was determined:

Allegation # 1: It was alleged that resident developed a pressure injury while in care. On 09/14/2021, 09/15/2021, 05/09/2022, 03/09/2023, 04/03/2023, 06/23/2023, and 08/23/2023, from various times, ranging from 8am to 4pm, LPA conducted interviews and reviewed medical records pertaining to resident # 1 (R1). Based on the information obtained, prior to being admitted to the facility, R1 had a series of medical issues, and was admitted to a skilled nursing facility (SNF) from 04/15/2021 through 04/28/2021, for wounds on the left and right leg, lateral ankle, and right heel. R1 was then admitted to the facility on 04/28/2021 with a history of lower extremities edema, diabetic issues, and previous wound care treatment. R1 was subsequently hospitalized several times, for various other medical health issues after being admitted to the facility.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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-20210914112329

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: WYNGATE VILLA GARDENS	FACILITY NUMBER: 197610099
	VISIT DATE: 09/20/2023

NARRATIVE

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Although, home health continued to treat the wounds for R1, medical records dated 09/28/2021 and 09/29/2021, report R1 was again admitted to the hospital and diagnosed with numerous stage III and unstageable wounds. Treatment was provided by the hospital, and R1 was discharged back to the facility.

Allegation #2: It was alleged that resident’s pressure injury developed maggots while in care. According to the medical report reviewed by LPA, dated 07/09/2023, R1 was admitted to the hospital and diagnosed with pressure injuries of the foot. Home Health was ordered, and treatment started 07/16/2021 for the right heel, and right lateral foot, 3x a week. Medical records dated 09/09/2021 through 09/10/2021, report hospital discovered maggots in R1’s heel. R1 was treated and discharged back to the facility. Records show while in the care at the facility, R1’s skin condition and wounds were getting worse and not healing. Facility continued to allow R1 to reside at the facility, when R1 developed a prohibited health condition. From 10/09/2021 through 10/15/2021, R1 was admitted to the hospital and eventually transferred to a SNF for further treatment of wound care for ulcers of right foot, as well as other health related issues. Therefore, based on medical review and records, LPA determined both allegations are SUBSTANTIATED. This poses as a immediate health and safety risk for residents in care.

The following deficiencies were cited per CA Code of Regulations Title 22 – see attached 9099D; and immediate $500 civil penalty will be issued.

An exit interview was conducted, a copy of this report and appeal rights was provided.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20210914112329

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: WYNGATE VILLA GARDENS	FACILITY NUMBER: 197610099
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/21/2023 Section Cited CCR 87615(a)(1)	1 2 3 4 5 6 7	Prohibited Health Conditions - (a) Persons who require health services for or have a health condition including...shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: based on record review	1 2 3 4 5 6 7	Administrator Oscar, must email LPA by POC date (09/21/2023), informing LPA how much time is needed to submit a written plan, describing how the facility shall prevent pressure injuries/wounds to residents in care; and understand what prohibited health conditions mean.
	8 9 10 11 12 13 14	& interviews, R1 developed and sustained, unstageable wounds, as well as stage 3 & 4 pressure injuries. Medical records also reported R1 developed maggots in the wound. This poses an immediate health and safety risk to residents in care. An immediate penalty of $500 will be assessed.	8 9 10 11 12 13 14	An immediate penalty of $500 shall be assessed as a result of the severe wounds developed on R1.
Type A 09/21/2023 Section Cited CCR 87464(d)	1 2 3 4 5 6 7	Basic Services. (d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs…., either directly or through outside resources.	1 2 3 4 5 6 7	By the POC due date (09/21/2023), the Administrator Oscar must email LPA regarding how much time is needed to submit a written plan, describing how the facility shall prevent injuries/wounds to residents as a results of deficiencies incurred by the facility.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by.Licensee did not ensure to continue to the appropriate care for R1, who was home health to treat wounds. R1 wounds developed into unstageable, stage 3 and 4 wounds, which resulted in R1 developing maggots in wounds. This is pose as an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	This POC will be included in the written plan for deficiency 87615(a)(1). It is not a separate plan.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC9099 (FAS) - (06/04)

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