198601976-12-14-2023-28-AS-TVAO-CYQNQC-20231221093941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601976
Report Date: 12/14/2023
Date Signed: 12/14/2023 09:56:42 AM

Unfounded

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
12/12/2023 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231212155347

FACILITY NAME:	DEL MAR PARK		FACILITY NUMBER:	198601976
ADMINISTRATOR:	DENISE SUTTON		FACILITY TYPE:	740
ADDRESS:	990 EAST DEL MAR BOULEVARD		TELEPHONE:	(626) 577-0215
CITY:	PASADENA	STATE: CA	ZIP CODE:	91106
CAPACITY:	60	CENSUS: 55	DATE:	12/14/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Denise Sutton/Administrator		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Questionable death.
Staff did not reposition resident resulting in resident sustaining a stage 4 pressure injury.
Staff did not change resident's diaper in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted an investigation for the above allegations. LPA met with Denise Sutton (Administrator) and discussed the purpose of today's visit.

LPA conducted a tour of the building and grounds and did not observe any signs of neglect, abuse or other immediate health and safety threats. During this visit, LPA obtained a copy of the staff and resident rosters, LPA reviewed and obtained copies of the Resident Daily Census reports for March 2023 through June 2023 and interviewed Denise Sutton (Administrator) and Dana Perez (Resident Service Coordinator).

Refer to LIC 9099C for the continuation of this report.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

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-20231212155347

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: DEL MAR PARK	FACILITY NUMBER: 198601976
	VISIT DATE: 12/14/2023

NARRATIVE

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It was alleged that R-1 had a questionable death, staff did not reposition R-1 resulting in R-1 sustaining a stage 4 pressure injury and staff did not change R-1's diaper in a timely manner. Per interviews, Resident#1 (R-1) has not resided at this facility. Resident Daily Census reports (noted above) do not reflect that R-1 was a resident at this facility. Staff interviews and reviewed documentation do not corroborate the above allegations.

This agency has investigated the complaint alleging R-1 had a questionable death, staff did not reposition R-1 resulting in R-1 sustaining a stage 4 pressure injury and staff did not change R-1's diaper in a timely manner. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted, a copy of the appeals rights and this report was provided to Denise Sutton.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

LIC9099 (FAS) - (06/04)

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