198602069-5-20-2022-11-AS-JHAD-CGC28H-20220714171021

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 10/19/2021
Date Signed: 05/20/2022 09:48:07 AM

Unsubstantiated

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
06/17/2021 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20210617090804

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: 116	DATE:	10/19/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	ADMINIISTRATOR PEGGY CLARK		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not take resident to be seen by a physician
Resident's dietary needs were not met
Staff did not properly assist resident with their medication
Staff did not attend to resident's call light in a timely manner
Staff allowed resident to sleep on her own vomit
Resident's responsible person was not informed of incident
Facility staff prevent resident from video calling their responsible person
Staff did not provide documentation to responsible person prior to increasing care fees to resident.

INVESTIGATION FINDINGS:

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On 10/19/2021 around 1:00 PM Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above. Today’s complaint investigation was conducted face to face with Administrator Peggy Clark.

The Investigation consisted of the following: On 06/21/2021 LPA Calderon interviewed Reporting Party (RP) for complaint. On 06/22/2021 LPA Calderon interviewed S1-S7 for complaint and on 07/01/2021 LPA Calderon interviewed R1-R11 for complaint. On 07/02/2021 LPA Calderon received and reviewed facility paperwork to included needs and service plan, physician report, MAR, hospital reports for complaint. LPA Calderon and Administrator (S1) and conducted a tour of the physical plant.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

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-20210617090804

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: 10/19/2021

NARRATIVE

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Allegation: Staff did not take resident to be seen by a physician.
It is alleged that staff refused to take resident to doctor’s appointment. On 06/21/2021 LPA Calderon interviewed witness for complaint who states that staff did not provide transportation for R1 to be seen by his doctor. On 07/02/2021 LPA Calderon received and reviewed paperwork for R1 the medical records stated that R1 was taken to the doctors office when needed or if R1 had an appointment On 06/22/2021 LPA Calderon interviewed S1-S7 for complaint all stated that they take residents to the doctor’s office when needed and there is no way they would deny a resident right to see their doctors. On 07/02/2021 LPA Calderon interviewed R1-R11 for complaint all stated that medical services are fine, that staff takes them to the doctor’s office when needed.

Allegation: Resident's dietary needs were not met.
It is alleged that Resident's 1 was not being feed properly by staff. On 06/21/2021 LPA Calderon interviewed witness) for complaint who states that staff were not following his doctors dietary plan and he was not eating. On 07/02/2021 LPA Calderon received and reviewed meal plan for facility and facility staff are following R1 dietary plan. On 06/22/2021 LPA Calderon interviewed S1-S7 for complaint all stated that staff does follow dietary plans for all residents if there are any issues with a resident meal plan staff contacts doctors for any updates. On 07/02/2021 LPA Calderon interviewed R1-R11 for complaint all stated that they receive meal plans from the facility and if they have a doctor’s meal plan, the facility works with them to make sure they get the correct food every day.

Allegation: Staff did not properly assist resident with their medication.
It is alleged that Staff did not properly assist resident with their medication. On 07/02/2021 LPA Calderon received and reviewed MAR paperwork for R1 the medical records dated 04/18/2021. Per medical paperwork R1 was given higher level of care and was given 5 medications per day. Based on medical paperwork there was no missing medication given to R1. On 06/22/2021 LPA Calderon interviewed S1-S7 for complaint all stated that the med-Tec have the MAR from the doctor’s office and give the correct medication every day and the medication is given to all residents on time. On 07/02/2021 LPA Calderon interviewed R2-R11 for complaint all stated that medical services are fine, that staff gives them their medication every day and on time. Residents have no concerns with staff taking care of their medication needs.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210617090804

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: 10/19/2021

NARRATIVE

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Allegation: Staff did not attend to resident's call light in a timely manner.
It is alleged that Staff took 25 minutes to respond to resident's call light. On 06/21/2021 LPA Calderon interviewed witness for complaint who states that staff did not respond to R1 pushing the call light bottom and that witnessed from a video camera that it took staff 25 minutes to arrive at residents’ room. On 06/22/2021 LPA Calderon interviewed S1-S7 for complaint all stated that depending on the situation at hand it may take 5 to 10 minutes for staff to arrive at a resident room or when the call light is pushed, but that it does not take 25 minutes as reporting party suggest. On 07/02/2021 LPA Calderon interviewed R2-R11 for complaint all stated staff does take 5 to 10 minutes to respond to a call light bottom, but that staff for the most part is very quick and arrives in time to take care of resident’s needs. On 10/19/2021 LPA Calderon tested the call light system for R1 and by the time the light was pushed it took staff 5 minutes to respond and arrive at room.
Allegation: Staff allowed resident to sleep on her own vomit.
It is alleged that R1 was sleeping and vomit on resident. On 06/21/2021 LPA Calderon interviewed witness for complaint who states that witness mother vomited all over R1 and R1 pushed the call button. Witness states that staff did not clean up the vomit and it took some time for staff to take care of resident. On 07/02/2021 LPA Calderon received and reviewed paperwork for R1 and there was no incident report that resident had vomit on R1. On 06/22/2021 LPA Calderon interviewed S1-S7 for complaint all stated that if a resident need to be cleaning they take care of any issue and write up a report to support what they have done. On 07/02/2021 LPA Calderon interviewed R2-R11 for complaint all stated that staff takes care of their needs and if there is a major issue like vomit, they clean the resident very fast.

Allegation: Resident's responsible person was not informed of incident.
It is alleged that resident’s family was not informed of incident. On 06/21/2021 LPA Calderon interviewed witness for complaint who states that R1 had vomit on R1 and staff had not responded and the facility did not inform witness of R1 status until he reviewed the video. On 07/02/2021 LPA Calderon received and reviewed paperwork for R1 and there was no incident report that resident had vomit on R1. On 06/22/2021 LPA Calderon interviewed S1-S7 for complaint all stated that if a resident need to be cleaning they take care of any issue and write up a report to support what they have done, and this would have generated a call to the responsible party. On 07/02/2021 LPA Calderon interviewed R2-R6 for complaint all stated that staff takes care of their needs and if there is a major issue like vomit, they clean the resident very fast. Residents stated that staff does inform their family members of any major situation.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20210617090804

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: 10/19/2021

NARRATIVE

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Allegation: Facility staff prevent resident from video calling their responsible person.
It is alleged that facility staff prevent resident from video calling family. On 06/21/2021 LPA Calderon interviewed witness for complaint who states that witness 1 stated that R1 is not allowed to use the phone or video calls to her family and that he had to purchase a phone for his mother’s communication needs. On 07/02/2021 LPA Calderon received and reviewed call logs for R1 and there was no indication that staff stopped or kept R1 from communicating with family. On 06/22/2021 LPA Calderon interviewed S1-S7 for complaint all stated that if a resident need to communicate with their family they do what they can to make sure this is done. On 07/02/2021 LPA Calderon interviewed R2-R11 for complaint all stated that staff takes care of their communication needs, but most residents have their own cell phones to call family members.

Allegation: Staff did not provide documentation to responsible person prior to increasing care fees to resident. It is alleged that Staff did not provide 60- day notice prior to increasing fees. On 06/21/2021 LPA Calderon interviewed witness for complaint who states that the facility increased fees for services and did not give 60-day notice as the admission agreements supports. On 07/02/2021 LPA Calderon received and reviewed admission agreement and notice that supports that the resident never returned from the hospital and was not a resident long enough for any increase in facility fees. On 06/22/2021 LPA Calderon interviewed S1 who stated R1 facility fees had not been increased prior to R1 leaving the facility. On 06/22/2021 LPA Calderon interviewed S2-S7 for complaint all stated that the administrator deals with increases for services and they have no knowledge of facility fee increases. On 07/02/2021 LPA Calderon interviewed R2-R11 for complaint all stated that over the years the facility has increased fees and they have received notice for same in a timely matter.

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

A face to face exit interview was conducted with Administrator Peggy Clark, and a hard copy was provided for records.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

LIC9099 (FAS) - (06/04)

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