198205144-6-19-2024-11-AS-JHAD-D6M295-20240626171120

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198205144
Report Date: 06/19/2024
Date Signed: 06/19/2024 05:55:33 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/17/2024 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240617085500

FACILITY NAME:	SANTA FE HOME CARE HOMES		FACILITY NUMBER:	198205144
ADMINISTRATOR:	ANGELIQUE GRADNEY		FACILITY TYPE:	740
ADDRESS:	2340 SANTA FE AVENUE		TELEPHONE:	(424) 488-2079
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY:	6	CENSUS: 4	DATE:	06/19/2024
		UNANNOUNCED	TIME BEGAN:	09:07 AM
MET WITH:	Christian Espino		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Illegal Eviction

INVESTIGATION FINDINGS:

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On 05/19/24, Licensing Program Analyst (LPA) Ernand Dabuet made a subsequent unannounced visit to this facility and was greeted by caregiver staff #1 (S3) Christian Espino. LPA Dabuet met with Anqelic Gradney who was able to present for this visit. LPA explained the purpose of today’s visit is to gather information for the allegation mentioned above and deliver findings.

The investigation consisted of the following: (LPA) Dabuet requested copies of files for resident #1 (R1)’s Admissions Agreement (dated: 08/10/23), Physicians Report LIC 602A (dated: 08/30/23), Register of Facility Residents LIC 9020 (dated: 02/01/24), and other documents associated with the complaint. Interviews were staff #1-#2 (S1-S2), and resident #1 (R1). A Collateral visit to Golden Senior Assisted Living II.

(Evaluation Report continues LIC 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

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-20240617085500

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA FE HOME CARE HOMES	FACILITY NUMBER: 198205144
	VISIT DATE: 06/19/2024

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Illegal Eviction.
It is alleged that resident #1 (R1) was illegally evicted from this facility. The complainant reported (R1) was admitted at Kaiser Permanente on 06/12/24 due to concerns with wounds. (R1) was evaluated, treated, and deemed safe for discharge. (R1) was not found to require a higher level of care. The hospital wound care specialist and Registered Nurse determined no infection, and the wounds were not open and appeared to be healing. The complainant reported the administrator declined to accept (R1) back to the facility and stated (R1) required a higher level of care due to the wounds.

According to resident #1 (R1)’s Admissions Agreement (dated: 08/10/23), (R1) was admitted to Santa Fe Home Care effective 08/10/23. Physicians Report LIC 624A (dated: 08/30/23) is non-ambulatory unable to self-care and requires assistance with assisted daily living (ADL). (R1) was under home health care for wound care with Human Touch Home Health Care from (May 2023 through October 2023).

An Unusual Incident Report LIC 624 (dated: 06/17/24) indicated nurse from Quality Home Health reported that (R1) has a bed sore and recommended that (R1) be evaluated at the hospital due to the bed sore and high level of care. (R1) was transported and admitted to Kaiser Permanente Medical Center Emergency Department on 06/12/24 for a wound problem. Kaiser Permanente medical records (dated: 06/19/24) revealed that sores were cleaned and treated with no indication of Stage 3 or 4 pressure injuries that are classified as a prohibited health condition and that (R1) would require a higher level of care. (R1) was authorized discharge with home health assistance by the hospital.

Investigation revealed (R1) was discharged on 06/14/24 from the hospital and was admitted to Golden Senior Assisted Living II and not Santa Fe Care Homes. (R1) was admitted to Golden Senior Assisted Living II on 06/14/24. On 06/17/24, (R1) was transported and readmitted to Kaiser Permanente Medical Center Emergency Department and has remained at the hospital waiting for discharge.

On 06/17/24 between 03:00 pm – 03:14 pm, the Department interviewed resident #1 (R1) verified being admitted at Golden Assisted Living and not Santa Fe where (R1) preferred to reside.
(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240617085500

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA FE HOME CARE HOMES	FACILITY NUMBER: 198205144
	VISIT DATE: 06/19/2024

NARRATIVE

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(R1) claimed not to have agreed with management for this move. (R1) is unaware of why (R1) was sent back to the hospital and why (R1) has not been released back to the facility. (R1) claimed the bed sores were healing and verified that (R1) was on home health for wound care.

On 06/19/24 between 10:30 am – 12:00 pm, the Department interviewed (2) out of (2) staff #1 - #2 who verified the reason for (R1) requiring medical emergency assistance at Kaiser Permanente Medical on 06/12/24 and 06/17/24. (S1) claimed that (R1) needed wound assessment for (R1)’s bedsores. (S1) claimed that (R1) required a higher level of care but did not receive medical evaluation from the hospital that (R1) had prohibited health conditions that would prevent (R1) to return at Santa Fe Care Home. (S2) indicated that (R1) exhibited contentious behavior that law enforcement was dispatched on 06/16/24, and it was deemed that (R1) required psychological assessment at the hospital. (S2) claimed that (R1) exhibited challenging behaviors in the past at Santa Fe Care Homes and that (R1) would benefit from a skilled nursing facility. (S2) expressed that (R1) had received an Eviction Notice from Santa Fe Home but was not able to provide a copy of the notice sent to Community Care Licensing for approval. (S2) had refused to accept (R1) to return to the facility based on the conditions for eviction that (R1) requires a higher level of care. Medical records indicated (R1) psychiatric behavior is normal.

On 06/19/24 between 10:30 am – 12:00 pm, the Department interviewed (2) out of (2) residents #2 - #3 at Golden Assisted Living both verified that (R1) did not cause any disruption at the facility and did not observe (R1) in exhibited unsafe behavior toward staff or residents.

Based on the information provided the facility failed to provide to (CCL) confirmation receipt that an Eviction Notice was sent. The El Segundo Regional Office (CCL) had no records on file. The facility failed to follow up with (CCL) for approval as written in Title 22 Regulations Section 87224 Eviction Procedures. (S1-S2) failed to follow up and contact the Department to inform an Eviction Notice was issued to (R1). (S2) failed to provide a copy of the notice. Interviews and records reviews support the above allegation.

Based on the Department's observation and interviews, records reviews, and analysis, the preponderance of evidence standard has been met, therefore the allegation of “Illegal Eviction" is Substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099-D.

An exit interview was conducted with Anqelic Gradney. The Rights were discussed with Anqelic Gradney and a copy of Appeals Procedures for Licensees was provided, as well as a copy of this report.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240617085500

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA FE HOME CARE HOMES	FACILITY NUMBER: 198205144
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/19/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/21/2024 Section Cited CCR 87224(b)	1 2 3 4 5 6 7	87224(b) The licensee may, upon obtaining prior written approval from the licensing agency, evict the resident upon three (3) days written notice to quit. The licensing agency may grant approval for the eviction upon a finding of good safety... mental and/or physical health or safety of others in the facility. Use. Good cause exists if the resident is engaging in behavior which is a threat to the mental and/or physical health or…	1 2 3 4 5 6 7	Licensee is to review Title 22 Regulation Section 87244 and resubmit a written statement to CCL to indicate it was reviewed and understood. Licensee will readmit (R1) back at the facility or submit a Plan to the Department on how to be in compliance with Title 22 Regulaitons by POC must be sent by fax to 424-544-1016 by 06/21/24.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews and record reviews. The facility failed to properly inform CCLD of an Eviction for (R1) and failed to provide evidence of notice submitted. The notice is not valid unless CCLD approves. This violation posed a potential health risk to residents in care.	8 9 10 11 12 13 14
Type B 06/28/2024 Section Cited CCR 87405(1)(2)	1 2 3 4 5 6 7	87405 Administrator – Qualifications and Duties (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations.	1 2 3 4 5 6 7	Licensee is to review Title 22 Regulation Section 8405 and resubmit a written statement to CCL to indicate it was reviewed and understood and submit by POC must be sent to LPA Dabuet at fax to 424-544-1016 by 06/21/24.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews and record reviews. The licensee evicted (R1) illegally without proper consent from CCL. This violation posed a potential health risk to residents in care.	8 9 10 11 12 13 14

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: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

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