198602069-1-11-2022-11-AS-MVAO-CBNVBM-20220215151747

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 01/11/2022
Date Signed: 01/11/2022 04:09:34 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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/24/2020 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20201124161136

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: 118	DATE:	01/11/2022
		UNANNOUNCED	TIME BEGAN:	03:22 AM
MET WITH:	Veronica Gomez-Asst. Administrator		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff neglect resulting in resident developing pressure injuries while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint investigation at above facility. LPA arrived at the facility and was greeted by receptionist. LPA explained purpose of visit was to deliver findings for the allegation listed above and was allowed entry to the facility to meet with Administrator Veronica Gomez

The investigation consisted of the following: On 11/5/2020 LPA spoke with administrator and was given a tour of the facility grounds. LPA saw dining room, kitchen, activity area and resident bedrooms. LPA requested the following documents: Physician’s report and other documents in association with the allegations were requested. On 2/2/2021 LPA interviewed residents 1-resident 11 (R1-R11) and staff 1-Staff 8 (S1-S8).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022

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-20201124161136

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: PALMCREST GRAND RESIDENCE	FACILITY NUMBER: 198602069
	VISIT DATE: 01/11/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Staff neglect resulting in resident developing pressure injuries while in care.

It is alleged that resident developed pressure injuries while in facilities care due to staff neglect. According to facility records R1 was on home health and there was a wound care order from doctor as well as a wound care plan given by the home health agency to treat the pressure injuries R1 gained while in skilled nursing care. R1 was sent to the hospital on 8/24/2020 and was admitted from the hospital to a skilled nursing facility from 8/30/2020 until 10/20/2020. In case notes from skilled nursing facility it was noted that resident had a pressure injury, but it was not the same one for which they were previously receiving home health. Upon return to facility on 10/20/2020 facility conducted a body check and contacted R1’s doctor regarding pressure injury. On 10/21/2020 Home health services ordered by physician, on the same day home health received the order and treated pressure injury. A few days later, on 10/24/2020 R1 was sent to the hospital. They were released on 10/30/2020 to skilled nursing care and did not return to facility before they were hospitalized again on 11/17/2020 which is when five pressure injuries were noted by hospital staff. LPA Cifuentes interviewed residents 2 - Residents 12 (R2-R12). R1 was not available for interview by LPA but it was noted that they did not feel there was any neglect on the facilities behalf. All residents interviewed stated they did not have any pressure injuries. When asked if they felt staff took good care of them, 10 out of the 11 interviewed stated they felt staff took good care of them, with one stating they needed no assistance. Based on information gathered and service records reviewed, the Department did not find sufficient evidence to support the allegation mentioned above.

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

Exit interview conducted, and a copy of the report was given to Assistant Administrator Veronica Gomez.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022

LIC9099 (FAS) - (06/04)

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