198603383-8-30-2022-28-AS-MVAO-CLUVLR-20221206153222

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603383
Report Date: 08/30/2022
Date Signed: 08/30/2022 02:55:39 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
08/26/2022 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20220826095508

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:	08/30/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Vicky Torres - Executive Director		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Staff is not assisting resident's with hygiene needs.
Staff is not assisting with resident's laundry needs.
Staff do not keep up with the cleanliness of resident's room.
Staff do not provide resident's toiletries.
Staff does not safeguard resident's personal items.
Facility's food services is inadequate.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA met with Vicky Torres - Executive Director and explained the reason for the visit.

The investigation consisted of the following: LPA Flores requested a copy of staff/resident roster, conducted a tour of the facility and observed room #101,108,110,117,120,206, activity rooms, laundry, and kitchen, conducted interviews with resident #1(R1),#2(R2),#3(R3),#4(R4),#5(R5),#6(R6) and staff #1(S1),#2(S2),#3(S3),#4(S4),#5(S5). LPA requested copies of caregiver shower logs for the past month, resident meal roster for 8/30/22, physician's reports, resident personal property and valueables, and resident service plan for R1,R2,R3,R4,R5,R6.

The investigation revealed the following: Regarding allegation: Staff is not assisting resident's with hygiene needs. It is alleged residents receive little or no individual care in regards to hygiene, or dressing.
(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

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 4

Control Number 28-AS-20220826095508

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: 08/30/2022

NARRATIVE

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Interviews with residents revealed 3 out of 6 residents stated staff assist with showers and change of clothes as needed. 1 out of 6 residents stated not to need assistance with showers or change of clothes. 2 out of 6 residents were unable to be interviewed due to cognitive skills. Interviews with staff revealed 4 out of 5 staff interview stated caregivers assist residents with showers and changing clothes. 1 out of 5 staff state to not be aware of the caregivers duties. Documents reviewed revealed residents' service plans have been conducted within the last year and note resident's need for assistance with bathing or change of clothes. Shower logs were reviewed and note residents' showers tracking a shower at least every three days with date and time shower provided.

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.

Regarding allegation: Staff is not assisting with resident's laundry needs. It is alleged that staff did not notice resident had soiled clothes in the room's floor. Interviews with residents revealed 3 out of 6 residents stated facility staff take care of the laundry for them. 2 out of 6 residents were unable to answer due to cognitive skills and 1 out of 6 residents stated facility does not do the laundry on a daily basis, but maybe every 3 days. Interviews with staff revealed 4 out of 5 staff stated currently caregivers during the night shift or evening shift are taking care of laundry daily and 1 out of 5 staff stated to not be aware of caregivers duties. During facilities tour LPA did not observed soiled clothes in the residents' rooms or bathrooms and laundry was being done for a resident during the tour.

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.

Regarding allegation: Staff do not keep up with the cleanliness of resident's room. It is alleged rooms are not cleaned weekly and there are messy rooms for days. Interviews with residents revealed 4 out of 6 residents stated facility maintains resident's rooms clean and 2 out of 6 residents were unable to be interviewed due to cognitive skills. Interviews with staff revealed 4 out of 5 staff stated facility has an outside service housekeeping company who deep cleans the facility once a week and maintenance director and caregivers assist with light housekeeping on a daily basis. During facility's tour LPA observed residents rooms clean, resident's bed sheets clean, and rooms were organized.
(CONTINUED LIC 9099C)

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20220826095508

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: 08/30/2022

NARRATIVE

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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.

Regarding allegation: Staff do not provide resident's toiletries. It is alleged "it's possible for there to be no toilet paper". Interviews with residents revealed 4 out of 6 residents stated to have toilet paper at all times in their rooms and toiletries available. 1 out of 6 residents stated not to have toilet paper available and 1 out of 6 residents was unable to answer due to cognitive skills. Interviews with staff revealed 4 out of 5 staff stated maintenance director or caregivers check bathrooms daily and provide toilet paper to each resident. During facility's tour LPA observed toilet paper or flush able wipes available in each residents' bathroom.

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.

Regarding allegation: Staff does not safeguard resident's personal items. It is alleged laundry taken to the laundry room when returned items were missing. Interviews with residents revealed 3 out of 6 residents stated to not have clothes missing after taking to laundry. 1 out of 6 residents stated to have had items gone missing after taken to laundry. 2 out of 6 residents were unable to answer due to cognitive skills. Interviews with staff revealed 4 out of 5 staff stated clothes has been misplaced but has been returned to the resident. Administrator stated a system is in place to prevent caregivers from confusing residents' clothes by placing a sticky note in the washer and dryer during the cycles and on top of the clothes when done which has been consisting for the last month. During facility's tour LPA observed laundry area and the sticky notes with resident's in washer, and dryer during the cycle. Facility maintains a resident property and valuables sheet for each 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 allegation is Unsubstantiated.

Regarding allegation: Facility's food services is inadequate. It is alleged resident miss meals as resident wasn't cued and no one noticed. Interviews with residents revealed 3 out of 6 residents stated to be reminded by staff before meals and not missed meals. 1 out of the 3 stated to also be aware of when meal times are happening. 1 out of 6 residents stated to be aware of meal times and not need of reminding. 1 out of 6 residents stated not to be reminded before meals and 1 out of 6 residents was unable to answer due to cognitive skills.
(CONTINUED LIC 9099C)

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20220826095508

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: 08/30/2022

NARRATIVE

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Interviews with staff revealed 5 out of 5 staff stated staff ensure all residents are present or encourage to join the dining room and managers maintain a meal roster which is check for each meal. Administrator stated a manager is in charge of checking residents per meal for the day and tracked in facility's resident meal roster to ensure each resident is account for during meals. Health Services Director stated resident meal roster is shredded at the end of the day as it is an internal document and copies for the month were unable to be provided. Resident Meal Roster reviewed for 8/30/22 had each resident name and room # with a row for breakfast, lunch, dinner, and status. Breakfast was checked for 24 out of 26 residents and code letter for the other 2 residents.

Based on interviews conducted and observations made, there was insufficient evidence to prove the allegation(s).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.

Exit interview was conducted with Vicky Torres Executive Director and a copy of this report was provided.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

LIC9099 (FAS) - (06/04)

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