198204893-1-30-2024-28-AS-LHIS-D26LE6-20240205074058

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204893
Report Date: 12/11/2023
Date Signed: 01/30/2024 10:05:46 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/01/2022 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20221201105032

FACILITY NAME:	CASSIDY'S HOME CARE		FACILITY NUMBER:	198204893
ADMINISTRATOR:	BRENDA CORPIN-GUINTO		FACILITY TYPE:	740
ADDRESS:	19627 WEIRSMA AVE.		TELEPHONE:	(562) 865-2314
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY:	0	CENSUS: 3	DATE:	12/11/2023
		UNANNOUNCED	TIME BEGAN:	08:52 AM
MET WITH:	Administrator Peter Nora		TIME COMPLETED:	12:18 PM

ALLEGATION(S):

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Staff neglect led to resident sustaining multiple pressure injuries
Resident sustained multiple UTIs while in care

INVESTIGATION FINDINGS:

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This LIC 9099 **supercedes the LIC 9099 that was previously recorded on 12/11/23**

On 12/11/23 at 8:52 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent visit to investigate the above listed allegations. LPA met with S1 and explained the reason for the visit. Administrator Peter Nora and Euphrosyn Dimaano joined the visit at 9:10 a.m., and LPA explained the reason for the visit.

During the initial visit dated 12/1/2022: LPA Baptiste toured the facility inside and out with administrator Peter Nora. LPA requested a copy of the staff roster, and resident roster. LPA also requested a copy of R1’s medical assessment/care and service plan, needs and service plan, R1 discharge documents dated medication list, Hospice residential agreement, resident care plan, admissions agreement, notes and emergency, power of attorney, and identification information. During the tour, LPA conducted a health and safety check which included a tour of the resident 5 bedrooms, 2-bathroom, dining room, garage, back yard, kitchen, and food supply. Report continued on 9099c

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

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 28-AS-20221201105032

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CASSIDY'S HOME CARE	FACILITY NUMBER: 198204893
	VISIT DATE: 12/11/2023

NARRATIVE

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LPA also received RN assessments dated 5/1/2022 to 10/16/2022 and Wound Pro notes dated 5/16/2022 to 5/16/2023 from Citcare hospice.

Prior to the visit LPA interviewed S1’s Hospice agency and Responsible party/ Power of Attorney who shall be referred to as Witness #1 (W1) and Witness # 2 (W2). LPA also received Hospice notes and assessments.

During today’s visit LPA interviewed a total of two (2) staff who shall be referred to as Staff #1 (S1) and Staff #2 (S2). LPA also interviewed a total to three (3) residents who shall be referred to as R2 through R4.

The investigation reveals the following: Regarding “Staff neglect led to resident sustaining multiple pressure injuries”. It is alleged that R1 sustained four (4) pressure injuries while in care. LPA interviewed Administrators Peter Nora and Euphrosyn Dimaano and confirmed the resident had multiple pressure injuries upon admission. They further stated that R1 had a wound care doctor visit the facility every Monday, and hospice staff visited three (3) times a week to do wound care. Both Administrators stated If there was a change of condition, they reported it to the hospice agency. The hospice agency would then provide care as needed to treat the resident. LPA interviewed witness #1 and confirmed they were happy with the care R1 received, and R1 was admitted into the facility with pressure injuries. Witness #2 stated that R1 was admitted with pressure injuries, and the facility took care of the resident. 2 out of 2 staff stated they rotated R1 every two hours and noted that R1 had pressure injuries upon admission. 3 out of 3 residents stated that the facility takes care of their needs, and they are happy living at the facility. LPA conducted a file review and noted that R1 was admitted to both the facility and hospice agency on 5/1/2022. R1 received an RN assessment two (2) times a month from 5/1/2022 to 10/16/2022. All assessments noted that R1 had multiple pressure injuries upon admission and obtained new injuries. The assessments also indicated the treatment plan R1 would receive. LPA noted two (2) separate agencies (hospice and wound pro) aside from the facility were visiting every week to provide care for R1’s wounds.

The investigation reveals the following: Regarding “Resident sustained multiple UTIs while in care” It is alleged that R1 had multiple UTIs because the facility was not changing the resident promptly. LPA interviewed the Administrators, who stated the resident was prone to getting UTIs because of a catheter and poor circulation from a medical diagnosis. The Administrators further stated that R1 was never diagnosed with UTIs, but the facility reported any change of condition to the hospice agency. After they report the change in condition, the hospice agency will treat the symptoms. During R1’s stay at the facility, they believed R1 had a UTI three (3) times. Witness #1 stated that R1’s doctor confirmed that R1 will have UTIs because of immobility and the catheter. Witness #2 stated they taught the caregivers at the facility how to care for R1 and that R1’s UTIs are related to the catheter. 2 out of 2 staff stated they never touched the catheter, but they cleaned the resident three (3) times a day. 3 out of 3 residents stated they love the staff, and their needs are being met. LPA reviewed S1 files and confirmed the resident had 3 UTIs during the last three (3) months of the resident’s life.

Based on LPA's interviews, and file review the investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Peter Nora and a copy of this record provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

LIC9099 (FAS) - (06/04)

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