198601543-3-19-2022-11-AS-AJKK-CCRL52-20220322082626

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601543
Report Date: 03/18/2022
Date Signed: 03/19/2022 07:05:26 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 DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/02/2021 and conducted by Evaluator Jey Cardenas

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210902085837

FACILITY NAME:	LUMIERE VILLA INC		FACILITY NUMBER:	198601543
ADMINISTRATOR:	NOLASCO MARASIGAN		FACILITY TYPE:	735
ADDRESS:	4167 W 168TH STREET		TELEPHONE:	(424) 247-9592
CITY:	LAWNDALE	STATE: CA	ZIP CODE:	90260
CAPACITY:	4	CENSUS: 2	DATE:	03/18/2022
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Meera Gopy		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Client has been chemically restrained while in care
Administrator Qualifications

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Jey Cardenas conducted an unannounced subsequent complaint visit at the facility to render findings on the above-mentioned allegation. LPA met with Administrator, Meera Gopy and explained the purpose of the visit. After interviews, observations, and record review the investigation revealed that there is no preponderance of evidence to support the following allegations: Client has been chemically restrained while in care and Administrator Qualifications.

The investigation consisted of the following: LPA interviewed Licensee, physician for client #1’ (C1), Reporting party, and attempted to interview C1. LPA reviewed C1s facility records, and toured physical plant.

It is alleged that: Client has been chemically restrained while in care. C1 is prescribed Ativan as a PRN (Lorazepam 1MG) , however Licensee has been administering Ativan 3 times a day as a routine medication since May2021.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 11-AS-20210902085837

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: LUMIERE VILLA INC	FACILITY NUMBER: 198601543
	VISIT DATE: 03/18/2022

NARRATIVE

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continued pg 2

On 9/10/2021 LPA Cardenas interviewed Licensee Meera Gopy and Rishideosi Mohabeer re: allegation: Client has been chemically restrained while in care. Meera states that that C1 is in need of Lorazepam three (3) times a day due to client is agitated; for example, on 9/08/2021 day program van arrived to pick up other clients, C1 ran out of the facility and chased after the van. C1 came close to crossing the street about five houses down from the facility. C1 has behaviors such as screaming throwing things, getting physically aggressive. Meera indicates that C1’s Physician prescribed client Lorazepam and orders are three (3) times a day for behaviors.
On 9/10/2021 LPA Cardenas reviewed C1’s medication sheet MAR for the month of July 2021 and August 2021: MAR sheet instructions indicate Lorezepam 1MG Tab “one tablet by mouth three (3) times daily as needed not to exceed 3 tablets in 24hrs; PRN AM, PRN PM, PRN HS. LPA stated to Meera that the instructions indicate medication is a PRN; Meera states, "thats an error.” Meera contacted physician who verbally told her that medication should be given three (3) times per day, and not as a PRN.

On 9/10/2021 LPA Cardenas interviewed Physician via telephone regarding prescribed medication Lorazepam 1MG TAB. Physician indicates that C1 should be given Ativan (lorazepam) 3xs a day for behaviors. He states that Ativan shouldn’t be a PRN; he doesn’t like PRNs because if patient is having behaviors it takes up to 45 minutes or longer to take effect. He states that he likes Ativan to be administered three times a day, thus medication is in the system and behavior doesn’t escalate. Physician indicates that Lorazepam was ordered as routine 3xs a day as of May 2021. LPA asked if there was anything in writing that was provided to the facility regarding the administering as a routine 3xs a day, he states he gave verbal orders. Physician indicates that the labels were an oversight and it shouldn’t have read PRN.

On 09/21/2021, at approximately 1218 hours, Investigations Bureau (IB) investigator, Lorraine Patterson interviewed Physician who disclosed he was previously called and asked by the facility and or a woman who worked at the facility about C1 medication, the woman reported C1 "got agitated," and that she wanted to know if C1 could be given his prescribed Lorazepam, 1 MG tab, generic for Ativan as a PRN. Dr. Smith told me that he does not prescribe this particular medication as a PRN, nor is it what he recommended.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 11-AS-20210902085837

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: LUMIERE VILLA INC	FACILITY NUMBER: 198601543
	VISIT DATE: 03/18/2022

NARRATIVE

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(continued pg 3)

Physician maintained that the prescribed prescription Lorazepam that he wrote for C1 which was prescribed to be taken 3x a day, at morning, noon, and night is what he prescribed to the patient. He then confirmed that the facility should have provided C1 with Lorazepam 1 MG tab, 3x daily, from May 2021, this medication administration would have been appropriate and as he recommended to reflect the correct dosage prescribed. Physician concluded, yes.. .3x daily, morning, noon and night was prescribed to the patient and was both the appropriate and recommended dose "as to this is what the patient presented."

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations(s) did or did not occur, therefore the allegations are unsubstantiated.

No deficiencies cited, Exit Interview conducted and report given.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Jey Cardenas
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

LIC9099 (FAS) - (06/04)

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