198602099-1-17-2024-11-AS-RORN-D3JNR5-20240320104059

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602099
Report Date: 01/17/2024
Date Signed: 01/17/2024 03:31:57 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
01/09/2024 and conducted by Evaluator Felisa Shirley

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240109085526

FACILITY NAME:	CORAL OAKS CARE LIVING		FACILITY NUMBER:	198602099
ADMINISTRATOR:	ELEANOR BARRIENTOS		FACILITY TYPE:	740
ADDRESS:	4271 CARLIN AVE		TELEPHONE:	(310) 763-4881
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	84	CENSUS: 73	DATE:	01/17/2024
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Eleanor Barrientos, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff not storing resident medications properly.
Facility staff spoke inappropriately to resident.

INVESTIGATION FINDINGS:

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On 1/17/24 Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced complaint visit to the address listed above. LPA arrived and spoke to Administrator Eleanor Barrientos and the purpose of the visit was discussed. LPA was granted access to the facility.

The investigation consisted of the following: On 1/17/24 LPA Shirley toured the facility’s first station for medication. LPA also requested and reviewed copies of the following records: Resident Roster, Staff roster, MAR’s, Forms Questionnaire, Preplacement Assessment, Functional Capability Assessment, Daily Communication Log, Appraisal Needs and Services 10/8/23, Admission Agreement and SIR’s that involved resident.

The investigation revealed the following:

Con’d on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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-20240109085526

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: CORAL OAKS CARE LIVING	FACILITY NUMBER: 198602099
	VISIT DATE: 01/17/2024

NARRATIVE

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Allegation: Facility staff not storing resident medications properly

It is being reported that resident returned their medications back to med-tech for storage but observed the box of medication the next day open at the nursing station not locked away. Resident also reported that when they requested staff to assist applying cream to their back, staff was not immediately available until done with another resident.

On 1/17/24 at 12:00p pm LPA Shirley reviewed resident file. During file review, LPA reviewed Physician’s Report and saw that R-1 is capable of managing own treatment/medication/equipment. Per Appraisal Needs and Services, R-1 is independent in ADL’s. LPA reviewed the MAR and found that R-1 self-administers all prescribed medications. During the tour of the first station where medications are stored, LPA observed that all medications were locked away in a separate room from nurse’s station. Nurses station is available 24 hours. LPA found it hard to not notice a box of medications easily accessible to residents in care, as technicians are monitoring activity at the counter and counter is free from clutter.

On 1/17/24 LPA Shirley interviewed resident 1 – resident 7 (R-1 - R-7). LPA asked, do you believe that staff is storing the medications correctly. Of those interviewed, 5 out of the 7 answered yes. R-1 was not available for interview. On 1/17/24 LPA Shirley interviewed staff 1-staff 7 (S-1 - S-7). LPA asked staff, where are the medications stored. Of those interviewed, 5 out of 7 staff answered locked at the first station.

Based on information gathered, the department did not find sufficient evidence to support allegations " Facility staff are not storing resident medications properly.” Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation: Facility staff spoke inappropriately to resident

On 1/17/24, LPA Shirley reviewed SIR’s during the time of residents stay. During review, LPA notes that there was only one SIR that involved inappropriate behavior from staff. LPA reviewed the one incident report

Con'd 9099-C

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240109085526

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: CORAL OAKS CARE LIVING	FACILITY NUMBER: 198602099
	VISIT DATE: 01/17/2024

NARRATIVE

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which also involves the resident. Resident made a mistake of accusing a caregiver of hitting her. LPA also reviewed memo from an IDT meeting in which the same resident accused a caregiver of demanding and yelling to open the door. Investigation was done and concluded with resident being mistaken.

On 1/17/24 LPA Shirley interviewed Staff, staff 1-staff 7 (S-1 - S-7). LPA ask, do you speak inappropriately to residents. Of those interviewed, 7 out of 7 answered, no. LPA Shirley interviewed residents, resident 1 – resident 7 (R-1 – R-7). LPA asked if staff has ever spoke inappropriately to you. Of those interviewed, 5 out of 7 answered, no!

Based on information gathered, the department did not find sufficient evidence to support allegations " Facility staff spoke inappropriately to resident.” Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted and a copy of the LIC 9099 and appeal rights forms were provided to Administrator Eleanor Barrientos.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

LIC9099 (FAS) - (06/04)

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