198601838-1-16-2024-28-AS-DSIS-D2WUK2-20240229143826

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601838
Report Date: 01/16/2024
Date Signed: 01/16/2024 03:41:32 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
01/09/2024 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240109164819

FACILITY NAME:	DOWNEY RETIREMENT CENTER		FACILITY NUMBER:	198601838
ADMINISTRATOR:	BRANDIE MENDIBLES		FACILITY TYPE:	740
ADDRESS:	11500 DOLAN AVENUE		TELEPHONE:	(562) 869-2416
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90241
CAPACITY:	252	CENSUS: 124	DATE:	01/16/2024
		UNANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:	Brandie Mendibles - Administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff not providing medical attention to resident’s pressure sore.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced 10-day complaint visit regarding the above allegation. LPA met with Jason Perez, Assistant to the Administrator and explained the purpose of the visit. Shortly after, Brandie Mendibles, Administrator arrived and assisted LPA with the investigation.

The investigation consisted of the following: LPA toured the facility and obtained copies of the resident and staff rosters. LPA reviewed R1's files such as: Identification and Emergency Information, Admission Agreement, Physician report (9/14/2023), Medication Administration Record (MAR) for Jan. 2024, and Charting Notes (Nov. 2023-Jan 2024). LPA also interviewed Staff #1 - Staff #5 (S1 – S5), Resident #1 - Resident #10 (R1 – R10) and Home Health Nurse (telephonically). *****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

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 28-AS-20240109164819

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DOWNEY RETIREMENT CENTER	FACILITY NUMBER: 198601838
	VISIT DATE: 01/16/2024

NARRATIVE

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The investigation revealed the following:

In regards to allegation: "Staff not providing medical attention to resident’s pressure sore." It is alleged that R1 has pressure sores and is given the run around by staff on who can assist with applying anti bacterial ointment. It is also alleged that R1 used to receive wound care but it stopped. Interviews conducted with 5 of 5 staff members denied this allegation. Staff members interviewed indicated that they assist all residents and do their checks and rounds including diaper changes to residents 3x per shift, or every 2-3 hours. Staff indicated that they were given instructions on R1's care and cleaning procedures which they follow. Staff interviewed indicated that they never refused a resident's request to put ointment or cream on them, but sometimes there are certain creams/ointments that caregivers cannot apply, only nurses can. Staff indicated that nurses are responsible to verify the correct dose, assess and monitor the stages of the residents wound. Interview with R1 indicated that R1 understands that caregivers and nurses have different functions and denied stating that R1 was given the run around by staff. R1 stated that he is able to move around and just requires some assistance or supervision. R1 also stated that the staff help him. R1 stated that N1 gave him recommendations on proper and faster healing techniques. Interview with N1 revealed that R1's pressure sore was superficial and R1 was provided wound care. N1 stated that R1's pressure sore has been healed since, hence wound care ended. Interviews conducted with 10 of 10 residents denied the allegation and never experience given a run around by staff. Interviewed residents also stated that the staff assist them when they ask. Additionally, residents indicated that the facility staff are helpful and nice to them. LPA reviewed documents and records that showed Home Health Nurse and facility staff provided medical attention to R1 and that the facility staff and Home Health nurse communicated regularly with regards to R1's pressure sores. Based on statements and interviews conducted with clients and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the allegation.

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 held and a copy of this report was provided to Brandie Mendibles, Facility Administrator.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

LIC9099 (FAS) - (06/04)

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