198601965-4-4-2024-11-AS-JCAN-D3ZR8B-20240404124741

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601965
Report Date: 02/22/2024
Date Signed: 04/04/2024 12:47:41 PM

Unsubstantiated

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
02/15/2024 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20240215135521

FACILITY NAME:	LURAY HOME		FACILITY NUMBER:	198601965
ADMINISTRATOR:	SHIRENA L MUHAMMAD		FACILITY TYPE:	735
ADDRESS:	930 E. LURAY STREET		TELEPHONE:	(562) 612-3752
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY:	3	CENSUS: 2	DATE:	02/22/2024
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	STAFF BRANDON HAYES		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not meet a resident's care needs

INVESTIGATION FINDINGS:

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THIS REPORT SUPERSEDES THE REPORT DATED 02/22/2024 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Luray Home facility on 02/22/2024 and was greeted by Staff Brandon Hayes (S2). LPA Calderon spoke to S2 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation and conducted an in-person interview with Staff Brandon Hayes (S2).

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

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-20240215135521

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: LURAY HOME	FACILITY NUMBER: 198601965
	VISIT DATE: 02/22/2024

NARRATIVE

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The investigation consisted of the following: LPA Calderon interviewed Staff (S1-S3), client (C1-C2) and witness (W1-W2). These interviews were conducted on 02/20/2024 and 02/22/2024. LPA Calderon obtain and reviewed the following: Physician’s report (dated 02/01/2024 to 02/29/2024) Needs and Service Plan (date 02/26/2020), Incident report (dated 01/08/2024), Gastro-Jejunostomy (G-Tube) training logs (date 06/29/2023), Harbor Regional Center incident reports (date 01/08/2024, 02/14/2024), daily body checks log notes (date 02/01/2024 to 02/21/2024), urine output log notes (date 02/01/2024 to 02/21/2024) for C1.

Regarding Allegation #1: Staff did not meet a resident’s care needs.

This complaint alleged lack of care as staff did not change C1 diaper prior to leaving facility. LPA Calderon interviewed with S1. S1 stated that S1 arrived at the facility around 8 am and was advised by W1 that S3 had not changed C1 diaper prior to leaving for Webster House. S1 states that W1 had cleaned C1 G-Tube area and had changed C1 diaper. LPA Calderon interviewed W1 who states that W1 arrived at the facility around 8 am and S3 had just left for Webster House. W1 states that W1 checked on C1 and noticed that C1 diaper was wet with urine and S3 had not changed C1 diaper prior to leaving. W1 reported the lack of care to S1. LPA Calderon interviewed staff (S2-S3). S2 states that S2 was not working on 02/14/2024 and did not witness the situation with C1. S2 states that S2 works with C1, and staff are to check C1 diaper every two hours and change resident diaper daily or when needed. S3 states that S3 arrived at the facility at 6:40 am and checked on C1 around 6:45am. S3 states that C1 was dry and C1 diaper did not need changing. S3 states that S3 was told by S1 to move to Webster House for work. S3 states that S3 waited for W1 to arrive prior to leaving. S3 states S3 should have checked on C1 prior to leaving for Webster House. S3 states S3 did not know what to do and S3 should have changed C1 diaper prior to leaving the facility. S3 states that not changing C1 diaper was a mistake and not a lack of care. LPA Calderon conducted an interview with W2. W2 states that W2 arrived at the facility around 8:15 am and S3 had left for Webster House. W2 did not witness if S3 had checked C1 diaper prior to leaving the facility. W2 states that W2 does not believe that S3 did not care for C1 needs as W2 states that W2 has checked clients in the past and the client’s diaper was dry and seconds later was wet with urine. W2 states that what happened to S3 could happen to any staff member. LPA Calderon attempted to interview C1 who was non-verbal and could not answer any questions. LPA Calderon interviewed C2 who states that staff takes care of C2 medical needs. C2 states that C2 does not wear a diaper and cares for C1 needs except meals and medications.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240215135521

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: LURAY HOME	FACILITY NUMBER: 198601965
	VISIT DATE: 02/22/2024

NARRATIVE

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Reviewed incident report (date 01/08/2024), On 01/08/2024 C1 was transported to the hospital for a leaking G-tube. C1 was admitted to the hospital and C1 G-tube was replaced. Reviewed Harbor Regional Center report (date 1/8/2024), W2 transported C1 to the Hospital due to leaking g-tube. G-tube was replaced by hospital staff. Reviewed Harbor Regional Center report (date 02/14/2024), report states that staff W1 arrived at the facility for W1 shift around 8am on 02/14/2024. W1 completed body checks for the two individuals. W1 found that client C2 was okay. W1 then checked C1 and found that C1 was saturated in urine and g-tube was leaking. W1 immediately assisted C1 out of the bed and into the wheelchair so that W1 could clean C1 and care for the individual due to the breakdown of the skin. S3 neglected to change C1 saturated brief and saturated gauze from the time S3 arrived on shift until staff W1 arrived. Reviewed daily body checks log notes for C1 (date 02/01/2024 to 02/21/2024), report notes that g-tube leaks and there is redness around leak. For 02/14/2024 log notes state that there was redness and rash around g-tube and that this was noted for AM, PM, and night shifts. Reviewed the urine output log (date 02/01/2024 to 02/21/2024), log notes that client urine output was noted as 3 times per am, PM and night shifts. Reviewed staff training logs for g-tube medication, g-tube training, g-tube dressing (date 06/29/2023) for C1. Log notes suggest that 6 staff including S3 signed the training log. Training notes state g-tube will be maintained in place and prevented from migrating, Gastrostomy (g-tube) care, staff to note redness, leakage, odor, clean with dry gauze after putting on gloves. Training in feeding clients with g-tube. Reviewed Needs and Service Plan (date 02/26/2020), difficulty understanding others and making C1 understood. Health issues noted, non-verbal.

Based on the information gathered, S3 checked on C1 at 6:45 am and found C1 to be dry and did not require a change in diaper and there did not appear to be any issue with C1’s G-tube. S3 left the facility before C1 was scheduled for another check. W1 checked C1 at 8:00am. Additionally, another staff person indicated that “she has seen clients check for a dry diaper and seconds later have a wet diaper. Staff state that they cannot control the client’s bladder and she does not think it was lack of care. Therefore, there is not sufficient evidence to support the allegation mentioned above.

An exit interview was conducted and copy of the Complaint Report was provided to the Staff (S2)

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

LIC9099 (FAS) - (06/04)

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