197610286-7-13-2022-31-AS-CHAS-CHPNV8-20220827104729

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610286
Report Date: 07/12/2022
Date Signed: 07/13/2022 08:07:53 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
07/08/2022 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20220708124028

FACILITY NAME:	PALM VISTA SENIOR LIVING		FACILITY NUMBER:	197610286
ADMINISTRATOR:	MONTALVO, STUART		FACILITY TYPE:	740
ADDRESS:	3850 WEST RANCHO VISTA BLVD		TELEPHONE:	(530) 242-8300
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	115	CENSUS: 12	DATE:	07/12/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Stuart Montalvo		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff retaining a resident that requires a higher level of care.
Staff does not ensure that resident receives wound care.
Memory Care Residents are not fed in a timely manner

INVESTIGATION FINDINGS:

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LPA Spaeth conducted an unannounced visit regarding the above-referenced allegations. LPA met with Administrator stated the purpose of the visit was to investigate a complaint regarding the above-referenced allegations. LPA and Administrator conducted a tour of the facility from 11:30 am until 12:00 noon. LPA did not observe any health and safety issues. LPA Spaeth interviewed staff members from 1:00 pm until 2:30 pm and reviewed resident files from 2:30 pm until 3:10 pm.

Staff retaining a resident that requires a higher level of care – The Resident Care Director (S2) stated there are twelve residents living in the facility and there are no residents who currently have a wound. S2 stated a current resident did have a wound but the wound has healed before resident moved into the facility. S2 stated resident does not need a higher level of care. LPA also interviewed the home health nurse who has been providing services to the resident for the past two weeks. The nurse verbally confirmed the wound has healed and the resident does not need a higher level of care. Therefore this allegation is unsubstantiated.

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: 07/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

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-20220708124028

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: PALM VISTA SENIOR LIVING	FACILITY NUMBER: 197610286
	VISIT DATE: 07/12/2022

NARRATIVE

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Staff did not ensure resident receives wound care - - LPA confirmed with the Resident Care Director who stated there are no facility residents who require wound care at this time. LPA reviewed six of the twelve resident files and did not observe residents who need wound care. LPA interviewed the Administrator who also confirmed there are no residents who require wound care. Therefore the allegation is unsubstantiated.

Memory Care Residents are not fed in a timely manner – During LPA’s tour, LPA observed dining staff serving lunch to the memory care residents at 11:50 am. LPA also interviewed three dining staff members who stated the memory care residents are always served first before the assisted living residents. The dining staff confirmed the reason for serving the memory care residents first is because the food is transported from the main dining room to the memory care section of the facility. Therefore this allegation is unsubstantiated.

Exit interview conducted, appeal rights discussed, and a copy of the report was given to the Administrator.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

LIC9099 (FAS) - (06/04)

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