198201977-6-11-2022-11-AS-MVAO-CFNSB5-20220623134322

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198201977
Report Date: 05/27/2022
Date Signed: 06/11/2022 10:01:07 PM

Unsubstantiated

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
04/11/2022 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20220411103413

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: 4	DATE:	05/27/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	CATHERINE RAYMUNDO		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident has a missing toenail.
Staff is not following resident's care plan.
Staff failed to seek medical attention in a timely manner.

INVESTIGATION FINDINGS:

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On 5/27/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted a subsequent unannounced complaint visit at this facility to deliver complaint findings. Upon arrival, LPA called the facility to conduct a risk-assessment. LPA spoke with Administrator Catherine Raymundo who confirmed the facility is Covid-19 free. LPA met with Administrator Raymundo and explained the purpose of today's visit.

The investigation consisted of the following: On 4/18/2022, LPA Lourdes Montoya conducted a tour of the inside and outside grounds of the facility; LPA Montoya interviewed the Licensee/Administrator, two caregivers, and one resident; LPA interviewed three witnesses (Witnesses #1-#3) by phone; LPA was unable to interview three residents due to their medical conditions. LPA reviewed Resident #1's service records and other pertinent records.

Report continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

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 11-AS-20220411103413

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: 05/27/2022

NARRATIVE

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INVESTIGATIONS REVEALED THE FOLLOWING:

Allegation: Resident has a missing toenail.

The Complainant or Reporting Party (RP) alleges Resident #1 has a missing toenail. RP claims Resident #1 was in a lot of pain which was caused by her toenail being ripped off of her toe. RP claims staff is responsible for Resident #’s missing toenail. The department conducted interviews with Staff #1-#3, Resident #2, and Witness #1-#3. Attempted interviews with Resident #1, #3, and #4 were unsuccessful. Interviews with Staff #1-#3 and Witness #1 and #3 revealed Resident #1’s toenail fell off and was not ripped off intentionally. Witness #1 (Resident #1’s Primary Physician) declared Resident #1 has a nail growing under the existing toenail and it is normal for the old toenail to fall off. Resident #2 and Witness #2 stated they have no knowledge of Resident #1’s missing toenail. Based on interviews and record reviews, there is no sufficient evidence to corroborate the allegation mentioned above.

Allegation: Staff is not following resident’s care plan.

The Reporting Party (RP) alleges staff is not following the resident’s care plan. RP claims staff are not following the plan of care for Resident #1. RP stated Resident #1 needs at least three times a day of breathing treatments or as needed and suction of built-up mucus. RP stated Resident #1 needs to be repositioned to avoid the build-up of mucus in her throat, but staff failed to turn her as indicated in her plan of care. The department conducted interviews with Staff #1-#3, Resident #2, and Witness #1-#3. Attempted interviews with Resident #1, #3, and #4 were unsuccessful. Based on LPA’s record review, the Appraisal/Need and Services Plan dated 12/3/2021 shows Resident #1 was taken out of hospice, stable, and is now under a doctor’s care; Resident is bedridden; Caregivers need to reposition Resident #1 every two hours. Witness #2 confirmed during an interview that Resident #1 was discharged from hospice due to health improvement. Interview with Witness #3 revealed the facility has been providing excellent home care and supervision to Resident #1 and has been lifted from hospice care which shows that staff are following Resident #1’s plan of care. Based on interviews and record reviews, there is no sufficient evidence to corroborate the allegation mentioned above.

REPORT CONTINUED IN LIC 9099C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220411103413

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: 05/27/2022

NARRATIVE

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Allegation: Staff failed to seek medical attention in a timely manner.

The Complainant or Reporting Party (RP) alleges staff failed to seek medical attention in a timely manner. RP stated there is no indication that Resident #1 received medical attention when she lost her toenail. The department conducted interviews with Staff #1-#3, Resident #2, and Witness #1-#3. Attempted interviews with Resident #1, #3,and #4 were unsuccessful. Based on LPA’s interview with Staff #1 and #2, Staff #2 applied first aid to Resident #1’s toe as soon as Staff #2 found the fallen toenail under Resident #’1 bedding. S2 stated she immediately called Resident #1’s doctor but the doctor was not available. Witness #3 admitted he does not know much about the details of Resident #1’s medical conditions but Witness #3 revealed Resident #1’s health has greatly improved since she moved into the facility five years ago and staff have been providing excellent care. Based on interviews and record reviews, there is no sufficient evidence to corroborate the allegation mentioned above.

Based on information gathered, LPA did not find sufficient evidence to support allegations, "Resident has a missing toenail", "Staff is not following resident's care plan", and “Staff failed to seek medical attention in a timely manner".

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED.

Exit conducted and a copy of the report was provided to Administrator Catherine Raymundo.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

LIC9099 (FAS) - (06/04)

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