198603217-12-4-2023-28-AS-RORN-CYASLR-20231207125846

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603217
Report Date: 12/04/2023
Date Signed: 12/04/2023 02:45:49 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
11/17/2023 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231117151545

FACILITY NAME:	DEL SOL HOME (CARPINTERO)		FACILITY NUMBER:	198603217
ADMINISTRATOR:	GONZALES, MERCI		FACILITY TYPE:	735
ADDRESS:	17926 CARPINTERO AVE		TELEPHONE:	(562) 243-4234
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	4	CENSUS: 4	DATE:	12/04/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Anna Marie Tomilloso - Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility staff did not assist resident with obtaining a prescription.
Facility staff did not observe a change in the resident's condition.
Facility staff did not properly supervise resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted the unannounced subsequent complaint visit to investigate the above allegations. LPA met with Direct Support Professionals (DSPs) Petronila Adlaon and Jordan Santos and explained the purpose of today's visit. The Administrator, Anna Marie Tomilloso arrived at 11:50am and discussed the purpose of today's visit.

During the initial complaint visit on 11/20/2023, LPA obtained copies of Client & Staff Rosters, C1 files such as; Identification and Emergency Information (FACE Sheet), Admission Agreement, Client's Personal Rights, Rights of Individual with Developmental Disability, Authorization to Consent to Treatment, Physician Report (08/11/2023), Individual Person Plan/IPP (04/18/2023), Individual Service Plan/Facility Report (10/26/2023), Hospital Discharge papers and SIR/Incident Report (11/15/2023). LPA interviewed Staff #1 (S1) - Staff #4 (S4), and Client #1 (C1).

During today's visit, LPA obtained the current staff & client rosters, Progress notes (Nov 2023), Nurse notes, photos of C1's wound and screenshot of communication between staff and Medical personnel/Program staff. LPA also toured the facility.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

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-20231117151545

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: DEL SOL HOME (CARPINTERO)	FACILITY NUMBER: 198603217
	VISIT DATE: 12/04/2023

NARRATIVE

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The investigation revealed the following:

In regards to the allegation: "Facility staff did not assist resident with obtaining a prescription.", it is alleged that the facility staff was informed of the need for antibiotics for C1 on 11/13/2023, but had not assisted resident with obtaining antibiotics, until 11/15/2023 when staff took C1 to the emergency room. Staff interviewed denied the allegation. Staff interviews revealed that on 11/13/2023, C1 received a scheduled check-up by her Nurse while at the Day Program. C1 gets checked-up by her Nurse on a regular basis, 3x a week. C1’s nurse took photos of C1’s wounds and sent a text message to the facility staff to ask the staff to send the photos to C1’s PCP and possibly get antibiotics. On the same day, 11/13/2023, S1 sent the photos to C1’s PCP and wound care Nurse. S1 stated that she did not get a response from the wound care nurse until 11/14/2023 and asked for a detailed description of the wound, but no antibiotics were prescribed. On 11/15/2023, C1’s PCP nurse contacted S1 and was instructed to take C1 to the ER, but no antibiotics were prescribed. The facility staff immediately followed C1’s PCP’s instruction and took C1 to the Emergency room the same day. Staff members interviewed also stated that the facility has in-house nurses who assist in obtaining prescriptions for the clients. Client interviewed could not corroborate the allegation and stated that staff assist in obtaining prescriptions every time. Therefore, there was insufficient evidence to corroborate with this allegation.

In regards to the allegation: "Facility staff did not observe a change in the resident's condition", it is alleged that on 11/09/2023, C1 has a wound that was about the size of a finger nail and was seen by the Physician on 11/10/2023. On 11/13/2023, The wound had grown larger and was infected and on 11/15/2023, the wound had grown to the size of a credit card. Interviewed staff members denied the allegation and indicated they always monitor C1’s condition as they are all aware of her skin picking disorder. Staff members stated that C1 has a chronic skin picking behavior. Staff indicated that they always redirect C1 whenever they see that she is starting to scratch or pick her skin. Staff indicated that this has been an ongoing issue with C1 since she was admitted in the facility in 2021. Staff members stated that the facility’s in-house nurses administer wound treatment to C1 daily. Staff stated that all staff on-duty conduct their rounds to monitor any changes to the clients condition. Staff also stated that they keep C1’s wound clean every day to avoid infection. Interviewed client cannot corroborate the allegation and stated that staff take good care of her and other clients in the facility. LPA reviewed files and documentation which showed that C1's doctor's visit on 11/10/2013 indicated that her wound has improved. The documentation reviewed also showed that the staff monitored and treated C1’s wound daily. Additionally, staff conducted rounds to check on clients on a regular basis. Therefore, there was insufficient evidence to corroborate with this allegation.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20231117151545

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: DEL SOL HOME (CARPINTERO)	FACILITY NUMBER: 198603217
	VISIT DATE: 12/04/2023

NARRATIVE

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In regards to the allegation: "Facility staff did not properly supervise resident", it is alleged that
at 4pm, facility staff left C1 in the ER waiting room even though C1 had not been admitted yet and had been engaging in self-harm behavior. C1 was in the ER waiting room without facility staff present from 4pm-10pm. Interviewed staff members denied the allegation. S5 stated C1 has been taken to the ER many times due to her recurring wounds caused by C1's behavior. On 11/13/2023, S5 stayed with C1 in the ER and spoke with the medical personnel to answer their questions and instructions about C1. While at the ER, S5 stated that S1 sent him a message to let him know that a Day Program Staff will go to ER willingly and voluntarily to visit C1. As ER only allows one (1) person inside with a patient, the ER nurse told S5 that he can leave and have the Day Program staff come in at around 4pm. Staff interviewed stated that if there is a possibility that client will be admitted, then staff leave client under the nurse’s supervision. Staff interviewed stated that C1 does not have a one-on one caregiver and there was no agreement with the Regional Center requiring that a staff be with the client at the Hospital 24/7. According to S5, before he left, he spoke with the Day program staff who was willing to stay with C1 who also left ER a few hours later. Staff also indicated that they provide adequate supervision to clients when they are at the Hospital. Staff interviewed stated that they hired a temporary sitter/caregiver from the Hospital as soon as C1 was admitted. Client interviewed indicated that a staff from the facility accompanies and stays with her when she goes to the doctor or the Hospital. Client interviewed indicated that there is sufficient staff to provide adequate supervision and monitoring to meet her needs. C1 indicated that she feels safe and comfortable at this facility. Therefore there was insufficient evidence to corroborate with the allegation.

Based on statements and interviews conducted with staff, client, review of clients files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations 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.

Exit interview held and a copy of this report was provided to the Administrator, Anna Marie Tomilloso.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC9099 (FAS) - (06/04)

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