198602069-1-31-2021-11-AS-MVAO-BYBS6F-20210217123552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 01/31/2021
Date Signed: 01/31/2021 03:28:02 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
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/08/2021 and conducted by Evaluator Jennifer Jones

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210108115301

FACILITY NAME:	PALMCREST GRAND RESIDENCE		FACILITY NUMBER:	198602069
ADMINISTRATOR:	LESLY FIGUEROA		FACILITY TYPE:	740
ADDRESS:	3503 CEDAR AVENUE		TELEPHONE:	(562) 595-4551
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90807
CAPACITY:	262	CENSUS: 108	DATE:	01/31/2021
		UNANNOUNCED	TIME BEGAN:	12:01 PM
MET WITH:	Peggy Clark, Compliance Coordinator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident developed a Stage 2 pressure injury while in care
Resident's clothes are soaked with urine and/or feces
Facility staff spoke inappropriately to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jennifer Jones initiated a complaint investigation and delivered 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 with Peggy Clark, Compliance Coordinator

On 01/15/21, LPA Jones discussed the allegations with Administrator Lesly Figueroa. LPA requested the following information: Resident and staff roster with phone numbers and staff start dates, changing and bathing schedule for residents 1 and 2 , appraisals and reappraisals for residents 1 and 2, progress note and home health information.
On 01/15/21, LPA Jones interviewed residents 1-10 and staff 2-6.

The investigation revealed the following: For allegation (Resident developed a Stage 2 pressure injury while in care).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2021

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-20210108115301

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
MONTEREY PARK, CA 91754

FACILITY NAME: PALMCREST GRAND RESIDENCE	FACILITY NUMBER: 198602069
	VISIT DATE: 01/31/2021

NARRATIVE

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It was alleged that a resident in care developed a Stage 2 pressure injury and the wound is not being treated properly. The administrator revealed doing an interview with LPA that the resident in care does not have a stage 2 pressure injury and the wound the resident did sustain is cleared up. The administrator stated that the facility LVN said resident's wound looked like a stage 2 pressure injury but after she observed the wound, it was not a stage 2. The administrator stated that the wound was not observed by a doctor or being treated by a doctor or nurse because the resident did not have pressure injury. The home health nurse reported to LPA that she was meeting with the resident once a week for another health condition and she observed the pressure injury. The home health nurse stated that at that time the wound was at a stage 1. The home health nurse stated that she had a doctor's order to treat the wound twice a week. The home health nurse stated that she was only able to treat the wound one time in early January 2021 and was told by the facility not come back due to a covid outbreak. The home health nurse did not observe the wound again until she was allowed to return back to the facility on 01/25/21. The home health nurse reported that the wound was completely healed on 01/25/21. LPA interviewed staff 2-6. Some of the staff stated that they never observed a wound on client in care. The remaining staff interviewed stated that they observed a wound but it cleared up when they assisted the resident the next time. LPA also interviewed residents 1-10. Resident 1 stated that he had a wound but it cleared up. Residents 2-6 stated that they have never had a wound while residing in the facility. .

For allegation (Resident's clothes are soaked with urine and/or feces) It was alleged that a resident in care is not being changed often and the resident's clothes are soaked in urine and feces. The administrator stated that the residents in care who require changing is changed during each shift (3 shifts in a day) and is checked 4 times per shift. The administrator did not have a documented changing log for the resident in care. Staff 2-6 stated that they have not observed any of the residents in care soaked in urine or feces. Staff 2-6 stated that each resident has a designated caregiver who assist them but they still check the residents when they come to their rooms for assistance. LPA interviewed residents 1-10. The interviews revealed as following: Some of the residents stated that they are independent and do require assistance, the other residents stated that they are changed often and has not be left soaked in urine or feces.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210108115301

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
MONTEREY PARK, CA 91754

FACILITY NAME: PALMCREST GRAND RESIDENCE	FACILITY NUMBER: 198602069
	VISIT DATE: 01/31/2021

NARRATIVE

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For allegation (Facility staff spoke inappropriately to resident) It was alleged that staff are rude to residents in care. Staff 1-6 stated they have not observed any of their colleagues being rude to the residents. Residents 1-10 revealed to LPA Jones during their interviews that staff are nice and they have not experienced any incidents of them being rude.

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

A telephonic exit interview was conducted with Peggy Clark, Compliance Coordinator and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2021

LIC9099 (FAS) - (06/04)

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