198201977-9-22-2020-11-AS-AJKK-BURU94-20201026152228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198201977
Report Date: 09/21/2020
Date Signed: 09/22/2020 09:26:48 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/14/2020 and conducted by Evaluator Jennifer Jones

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20200414154526

FACILITY NAME:	SANCTUARY, THE		FACILITY NUMBER:	198201977
ADMINISTRATOR:	CATHERINE RAYMUNDO		FACILITY TYPE:	740
ADDRESS:	21410 MADRONA AVENUE		TELEPHONE:	(424) 558-3134
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	6	CENSUS: 5	DATE:	09/21/2020
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Catherine Raymundo, Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not provide resident access to phone calls.
Resident is dehydrated.
Facility does not meet resident’s needs.
Facility staff are not transferring resident properly
Facility staff are using postural supports without physicians’ orders

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jennifer Jones initiated a subsequent complaint investigation to deliver findings for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Catherine Raymundo, the facility administrator and Licensee.

On 04/23/20, LPA Jones conducted telephone interview with the administrator, LPA requested copies of current staff/resident roster, admissions agreement, house rules, pre-placement appraisal, physician’s report,
emergency contact information, hospice records, visitors log and resident's progress notes.

On 04/27/20, LPA Jones conducted televisit which consisted of observation of the physical plant inside and outside, a demonstration by staff on how they use the hydraulic lift and safety belt. LPA attempted to interview R1 during the televisit.
During today's visit, LPA delivered findings to the administrator, Catherine Raymundo.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2020

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 11-AS-20200414154526

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SANCTUARY, THE	FACILITY NUMBER: 198201977
	VISIT DATE: 09/21/2020

NARRATIVE

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The allegation revealed the following: for allegation (Staff did not provide resident access to phone calls.) It was alleged that the facility landline was not operable the residents do not have access to a telephone to communicate with family. The administrator revealed during a telephone interview that the facility landline is inoperable. The administrator stated the problem started with the facility landline around March 29 - April 1st and it was fixed on April 28, 2020. The administrator stated that it took while to have the landline repaired because the cable companies were not conducting house calls due to covid-19. The administrator stated the staff were allowing the residents to use their cells phones to communicate with their families.

The allegation revealed the following: for allegation (Resident is dehydrated) It was alleged that the facility is blending R1’s food and R1 does not like it. It was also alleged that R1 is not getting enough water to drink. Staff 1-4 revealed during their interviews that resident 1 drinks a glass of water 3xs a day with a spoon. The hospice agency stated they do not have any concerns with R1 being dehydrated due to negligence from the facility. Hospice reported that R1 has a poor appetite with a 50% oral intake. Hospice provided LPA with a doctors order for a pureed diet. Hospice stated that they are unable to weight R1 on a scale due to her health condition, so R1’s weight is measured by her arms during every visit. Hospice stated they are able to determine if R1 is losing or gaining weight by takings measurements of her arms. Hospice also provided LPA with care plan for the resident 1 and also a copy of R1’s vital signs and a complete assessment of R1’s food and fluid intake. R1’s conservator revealed during his interview that he communicates with the facility often and he does not have any concerns of the care R1 is receiving.

For allegation (Facility does not meet resident’s needs) It was alleged that R1’s hygiene needs aren’t being met. Staff 1-4 stated that they assist R1 with brushing her teeth and bed baths daily.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20200414154526

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SANCTUARY, THE	FACILITY NUMBER: 198201977
	VISIT DATE: 09/21/2020

NARRATIVE

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Hospice advised LPA that they assist with giving R1 a bath during their visit three times a week. On 04/27/20, LPA observe R1 during a tele-visit with the facility. R1 appeared to be manicured and groomed. LPA attempted to ask R1 questions through the video but R1 was unable to give LPA a response.

For allegation (Facility staff are not transferring resident properly) It was alleged that the facility is not transferring R1 into her wheelchair properly and R1’s wheelchair is not the right size. It was alleged that the facility downsized the wheelchair to fit inside the home, but the wheelchair is not suitable for R1’s size. Hospice revealed during an interview that R1 has the appropriate size
wheelchair. Hospice stated that if the wheelchair is larger then it will cause R1 to slide down. Hospice stated that the wheelchair R1 uses give her the snug fit which is appropriate. Hospice provided LPA a copy of the wheelchair size order. Staff 1-4 revealed during their interviews that
they are transferring R1 by using a hydraulic lift. LPA Jones observed training certification dated 03/29/20 for staff 1-4 in hydraulic lift and safety belt. Staff demonstrated during a tele-visit 04/27/20 with LPA on how they use the hydraulic lift and safety belt.

For allegation (Facility staff are using postural supports without physicians’ orders) It was alleged that the facility is strapping R1 down with a belt so R1 cannot get up. LPA received a doctor’s order for lap belt to be used for safety while R1 is in the wheelchair. Staff 1-4 said they use the safety belt as additional support for R1. LPA observed staff training dated 03/29/20 for the lap belt.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation are unsubstantiated.
Exit interview conducted and a copy of the report was issued to the administrator for an electronic signature.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2020

LIC9099 (FAS) - (06/04)

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