198602870-10-3-2023-28-AS-RORN-CWHQY3-20231011123429

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602870
Report Date: 10/03/2023
Date Signed: 10/03/2023 03:31:15 PM

Unsubstantiated

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
09/28/2023 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230928164203

FACILITY NAME:	SERENTO CASA		FACILITY NUMBER:	198602870
ADMINISTRATOR:	SARAH SESAY		FACILITY TYPE:	741
ADDRESS:	1740 SAN DIMAS AVENUE		TELEPHONE:	(909) 394-0304
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	131	CENSUS: 41	DATE:	10/03/2023
		UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Heather O'Neel, Health Services Director		TIME COMPLETED:	03:39 PM

ALLEGATION(S):

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Facility did not seek medical attention for a resident in care.
Staff did not keep facility free of insects.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alberto Lopez made unannounced 10-day visit to investigate the above allegations. LPA met with Health Services Director Heather O’Neel and discussed the purpose of the visit.

The investigation consisted of LPA reviewing and obtained copy of staff and staff rosters, text messages with photos of conversation between S5 and R1 Primary Physician dated 08/10/2023-09/20/23, Home Health documentation for wound care dated 09/06/23, 09/08/23, 9/11/23, 09/13/23, 09/15/23, 09/18/23, 09/20/23, and 09/22/23, R1 Physicians report, Point Click Care progress notes for R1 from 08/30/23-09/21/23, R1 Primary Physician orders for R1 for 08/10/23-10/31/23, Discharge Summary for R1 Urgent care visit on 08/15/2023, ECOLAB Pest Elimination invoices dated 06/28/23, 07/29/23, 08/28/29, 09/18/23 (2) and interviewed six staff (S#1-S#6) and eleven residents (R#1-R#11).

(Continued on 9099D)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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 28-AS-20230928164203

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: SERENTO CASA	FACILITY NUMBER: 198602870
	VISIT DATE: 10/03/2023

NARRATIVE

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Allegation: Facility did not seek medical attention for a resident in care. It is alleged that resident suffered a spider bite on 08/10/2023 and notified staff and staff did not seek medical attention for the bite.

The investigation revealed the following:

The investigation revealed that S5 notified R1 Primary Physician by text message with photo of bite wound on 08/10/2023 after notified by R1 that R1 had a spider bite. R1 Primary Physician then sent treatment orders for R1 spider bite that consisted of cleaning with normal saline and apply triple antibiotic ointment daily. On August 15, 2023, R1 was prescribed oral antibiotics by R1 Primary Physician. On August 22, 2023, R1 Primary Physician made visit to facility to examine R1. R1 primary doctor did not order anything during the visit. R1 can handle R1 own medications per Primary Physician orders. On August 24^th R1 stated R1 did not want to take R1 antibiotics. On the same day S5 notified family of R1 that Home Health referral will be made. On August 28^th S5 sent message to R1 Primary Physician to follow up on order for home health because the wound was not healing. On August 30^th, 2023, S5 again follow up on home Health referral with R1 Primary Physician. At 11:18AM Home Health agency called to report that they were coming later that day. Home health arrived that same day and treated R1 wound. Home Health was coming once a week to treat wound. On the September 15^th, 2023, R1 suffered another spider bite on R1 left hand. S5 notified R1 Primary Physician the same day and Primary Physician ordered to apply ice and Benadryl cream on bite. The Benadryl cream worked according to S5. R1 applied R1 own cream. On September 20^th S5 sent another text to the doctor notifying Primary Physician of the progress and Primary Physician made visit on September 21^st and had no concerns and no new orders. Family took R1 out of facility on September 27^th and has not yet returned. LPA interviewed 12 residents and 11/12 residents did not collaborate the allegations and 11/12 residents stated they get there needs met or have not yet required medical attention. LPA interviewed 6 staff and 6 of 6 staff denied the allegations.

Based on the information obtained, the allegation is unsubstantiated.

(continued on 9099C)

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20230928164203

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: SERENTO CASA	FACILITY NUMBER: 198602870
	VISIT DATE: 10/03/2023

NARRATIVE

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Allegation: Staff did not keep facility free of insects. It is alleged that R1 room has spiders and facility has not done anything to keep facility free of insects.

LPA interviewed 6 staff and 6 of 6 staff denied the allegation. 6 of 6 staff stated that facility is addressing the issue. S4 stated that Pest Control ECOLAB comes once a month and sprays pesticide outside the facility to control insects and that facility sought authorization to use a solution Finito, inside of R1 room to address the spider(s) that may be in the room. LPA interviewed 11 residents and 9 of 11 residents stated they have not seen any spiders in their rooms. R11 stated R11 suffered a spider bite a few weeks ago but never notified staff. R11 stated R11 has not seen any spiders in R11 room recently. 10 of 11 residents interviewed stated the spider issue is now resolved. LPA inspected rooms 151, 152, 153, 154, and 155 thoroughly and did not observe any evidence of spiders or other insects in the rooms. LPA toured the common areas and found no evidence of spiders or other insects inside the facility.

Based on the information obtained, the allegation is unsubstantiated.

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. Exit interview held and a copy of the report and appeal rights was provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC9099 (FAS) - (06/04)

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