198603383-7-21-2022-28-AS-MVAO-CH7RGC-20220811130032

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603383
Report Date: 07/21/2022
Date Signed: 07/21/2022 12:48:33 PM

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 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
11/30/2021 and conducted by Evaluator Tony Vasallo

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211130113301

FACILITY NAME:	TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THE		FACILITY NUMBER:	198603383
ADMINISTRATOR:	HIGGINS, DEBORAH		FACILITY TYPE:	740
ADDRESS:	1155 VIA VERDE		TELEPHONE:	(503) 443-1818
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	60	CENSUS: 26	DATE:	07/21/2022
		UNANNOUNCED	TIME BEGAN:	11:01 AM
MET WITH:	Vicky Torres, Administrator		TIME COMPLETED:	01:05 PM

ALLEGATION(S):

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Resident sustained multiple pressure injuries while in care.
Staff did not seek medical attention for resident in a timely manner.
Staff did not give resident medications as prescribed.
Staff did not ensure that resident's hygiene needs were met.
Facility is retaining a resident that requires a higher level of care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vasallo conducted a subsequent complaint visit to investigate the allegations listed above. LPA met with Administrator, Vicky Torres and explained the reason for the visit. LPA conducted the initial complaint visit on 12/1/21. Investigator, Kujawa investigated further.

The investigation consisted of the following: Interviews were conducted with facility staff. Documents were reviewed which included facility notes, hospice care notes, home health records, physician’s report, preplacement appraisal, emergency contacts, Power of Attorney (POA) documents, Medication Administration Record (MAR), and physician’s notes and prescriptions.

The investigation revealed the following: Allegation - Resident sustained multiple pressure injuries while in care. On 11/19/21, facility noted skin irritation on Resident #1 (R1). On 11/28/21, facility noted R1 had an open wound on right buttocks. On 11/29/21, facility contacted home health to evaluate the wound. Family was also notified of the wound. Continued on 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

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 28-AS-20211130113301

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THE	FACILITY NUMBER: 198603383
	VISIT DATE: 07/21/2022

NARRATIVE

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On 11/30/21, home health visits facility for wound treatment. On 12/1/21, R1 admitted on hospice and wound was diagnosed as a Stage 3. Care plan was developed by hospice agency. Notes indicate it is unclear how the wound developed since R1 is ambulatory and very active. Interviews conducted with staff revealed that they were aware of the wound and R1’s skin condition. Facility staff report communicating with the family and medical professionals about R1’s skin condition. Based on the information obtained, there is no evidence to suggest facility neglected R1 which resulted in pressures injuries. Therefore, the allegation is unsubstantiated.

Allegation - Staff did not seek medical attention for resident in a timely manner. Facility notes, physician’s orders and medical records revealed facility documented any changes of condition to R1. R1 obtained proper care for skin issues by being prescribed ointments/creams and wound care. There was no evidence that facility neglected any medical issues. Based on the information obtained, the allegation is unsubstantiated.

Allegation - Staff did not give resident medications as prescribed. Medication records indicate R1 obtained all medications as prescribed. Physician’s orders indicate R1 obtained creams for skin issues and wound care. Facility did document when R1 was agitated and aggressive with staff and would not allow skin treatments. Home health also documented aggressive behavior when attempting to evaluate R1’s skin. There was no evidence to suggest R1 did not obtain medications as prescribed. Therefore, the allegation is unsubstantiated.

Allegation - Staff did not ensure that resident's hygiene needs were met. Staff documented when R1 would refuse a bath and would be aggressive with staff. Staff interviewed also confirmed R1 was aggressive at times. Staff indicated if R1 was having less behaviors one day they would assist R1 with a bath even though R1 was not on the schedule that day. Based on the information obtained, the allegation is unsubstantiated.

Allegation - Facility is retaining a resident that requires a higher level of care. R1 was diagnosed with a Stage 3 wound which was being treated by medical professionals including a hospice agency. Based on observations, interviews conducted and records reviewed, R1 was fully ambulatory and often walked around the facility unassisted. None of the records reviewed revealed that R1 was diagnosed with a condition that was unsuitable for this type of facility. Based on the information obtained, there was no evidence to prove the allegation. Therefore, the allegation is unsubstantiated. R1 has advanced dementia, therefore R1 was not interviewed.

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 allegations are unsubstantiated.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

LIC9099 (FAS) - (06/04)

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