198320032-8-13-2020-11-AS-AJKK-BSUT7Z-20200826142934

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320032
Report Date: 08/04/2020
Date Signed: 08/13/2020 04:34:21 PM

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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/27/2020 and conducted by Evaluator Lourdes Montoya

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20200527135443

FACILITY NAME:	KENSINGTON REDONDO BEACH, THE		FACILITY NUMBER:	198320032
ADMINISTRATOR:	MAY, ROBERT		FACILITY TYPE:	740
ADDRESS:	801 S PACIFICA COAST HIGHWAY		TELEPHONE:	(424) 241-2064
CITY:	REDONDO BEACH	STATE: CA	ZIP CODE:	90277
CAPACITY:	132	CENSUS: 64	DATE:	08/04/2020
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Robert May		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Unexplained bruising on resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced complaint tele-visit to deliver findings for the allegation 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/FaceTime with Robert May, the facility administrator and Julie Lacey, Director of Nursing.

Investigation consisted of the following: A telephone/video inspection of the physical plant. A review of current staff/resident roster, facility files of residents (R1-R2), staff schedules, and incident reports dated 4/12/2020, 5/11/2020 and 5/28/2020. Interview with staff (S1-S4) and R1's family. LPA attempted to interview S5 and S6 but both staff were not available. LPA attempted to interview residents but due to their medical conditions, LPA was not able to conduct interviews.

REPORT CONTINUED IN LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2020

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-20200527135443

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
MONTERY PARK, CA 91754

FACILITY NAME: KENSINGTON REDONDO BEACH, THE	FACILITY NUMBER: 198320032
	VISIT DATE: 08/04/2020

NARRATIVE

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Allegation: Unexplained bruising on resident

Based on record review, R1 was admitted at this facility on 1/24/2019. R1 is ambulatory but she is confused and disoriented due to her dementia. R1 has aggressive, wandering, inappropriate and sundowning behaviors. R1 is not able to follow instructions and not able to communicate her needs. Review of facility's clinical notes dated 3/15/2020 through 5/24/2020 revealed R1 was noted with combative behavior and episode of hitting staff and other residents. R1's self-inflicted falls were also noted. Staff monitor changes on R1's behavior and health daily. Staff reports every incident to R1's family and staff consult with R1's primary physician when needed.

Review of an incident report dated 4/12/2020 indicates R1 was noted to have bruising on left side of breast and S4 was called to assess her. R1’s family and doctor were informed of the injury. There were no reported incidents that contributed to the observed bruising. Interview with S2 and S4 revealed no one witnessed how R1 acquired bruise.

Review of an incident report dated 5/11/2020 and interview with S2 and S3 revealed R1 had an altercation with R2 in the activity room. S2, S3 and S5 witnessed the incident. All three staff immediately assisted both residents. S5 separated R1 and R2. S5 redirected R2 while S3 engaged with R1 while observing her for health and safety check. S2 assessed R1 then later assessed R2. S2, S3 and S5 observed a bruise on R1's chest while no sign of injury was found on R2. S2 informed R1’s family via email about the altercation between R1 and R2 that resulted to R1 having a bruise on her chest. R1's family replied and said "Talk about a love hate relationship, the lovely journey of Alzheimer's. Thank you for letting me know".

Review of incident report dated 5/28/2020 indicates R1 was noted with swelling and discoloration on left hand. R1 did not appear to have any signs or symptoms of pain or grimacing. S4 immediately assessed R1 and applied cold compress on R1's left hand. R1's family and doctor were informed. Interview with S4 revealed she thinks R1 may have bumped her left hand on a rail in the hallway while walking around her neighborhood on that day. Interview with S2 revealed no one witnessed how the resident acquired the swelling and skin discoloration, staff were questioned but no one witnessed any incident.

REPORT CONTINUED IN LIC 9099C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2020

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20200527135443

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
MONTERY PARK, CA 91754

FACILITY NAME: KENSINGTON REDONDO BEACH, THE	FACILITY NUMBER: 198320032
	VISIT DATE: 08/04/2020

NARRATIVE

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Interview with R1's family revealed, R1 can be combative and known to have aggressive behavior. Record review indicates R1's family was informed of all three incidents (4/12/2020, 5/11/2020 and 5/28/2020) but during LPA's interview, R1's family did not mention or complain about R1's bruise on her chest or any other injury incidents.

Per LPA’s observation, record review and interview, facility staff ensure that R1 and all other residents are consistently supervised, assessed and monitored when injury occurs, residents' family members are informed and resident's doctor is consulted when necessary. Facility staff did not fail to ensure residents' health and safety.

Based on information gathered, LPA did not find sufficient evidence to support the allegation, “Unexplained bruising on resident". This is evidenced by LPA’s observations, interviews and record review.

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 complaint investigation of the allegation is UNSUBSTANTIATED.

No Deficiencies cited under California Code of Regulations Title 22 and Health and Safety Codes.

A telephonic exit interview was conducted with Robert May, and an electronic copy was sent via email for signature.

LPA advised the administrator, Robert May, to sign the report (LIC 9099) and email it back to Lourdes.Montoya@dss.ca.gov.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2020

LIC9099 (FAS) - (06/04)

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