198603504-7-6-2023-28-AS-LHIS-CVDKDU-20230905074918

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603504
Report Date: 07/06/2023
Date Signed: 07/06/2023 01:30:52 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
06/30/2023 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230630083050

FACILITY NAME:	LA POSADA		FACILITY NUMBER:	198603504
ADMINISTRATOR:	DIANA BAUTISTA		FACILITY TYPE:	740
ADDRESS:	8120 PAINTER AVE		TELEPHONE:	(562) 945-2651
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90602
CAPACITY:	114	CENSUS: 88	DATE:	07/06/2023
		UNANNOUNCED	TIME BEGAN:	08:39 AM
MET WITH:	Diana Bautista, Administrator		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Lack of supervision resulting in resident being struck/hit while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial 10-Day complaint visit to investigate the above allegation.The purpose of the visit was discussed with Med-Tech Stephanie Varela. Administrator Diana Bautista arrived later.

The investigation consisted of the following: A tour of the facility was conducted with focus in the Memory Care Unit. No health and safety concerns were observed. Residents (R1- R6) and staff (S1- S4) were interviewed. Resident (R1 & R2's) files were reviewed. The following documents were obtained: Identification and Emergency Information/Face Sheet, Physician Report, Resident Assessment, Needs and Services Plan, Physician Communication documents, End of Shift Report (6/26/23- 6/27/23), Narrative Charting, resident roster, and LIC 500 Personnel Report. *** R1 & R2's Physician reports are not updated. Dementia residents shall have an annual medical assessment and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. Citation was issued in case management report.
***Narrative continues next page.***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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-20230630083050

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: LA POSADA	FACILITY NUMBER: 198603504
	VISIT DATE: 07/06/2023

NARRATIVE

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Allegation: Lack of supervision resulting in resident being struck/hit while in care. It is alleged that a resident in the Memory Care Unit physically assaulted another resident. Based on interviews conducted and record review, on June 26, 2023 at approximately 8:30 PM, resident (R1) and resident (R2) were sitting next to each other and resident (R1) became agitated by resident (R2's) humming and tapping behavior; subsequently hitting resident (R2) at least three times in the upper head area. Per staff interviews, resident (R1) has history of minor altercations and at times aggressive and threatening behaviors towards residents and staff. In recent months, resident (R1's) aggressive behaviors have worsened. Family has been contacted and the resident is awaiting to be seen by a specialist medical professional.

A total of four (4) staff were interviewed whom denied the allegation by stating that the Memory Care Unit has at minimum two (2) staff at all times. On the date of the incident there were three (3) staff on NOC shift. A staff was present when R1 hit R2, but due to R1's impulsive and aggressive behavior staff were unable to prevent the incident. Resident (R1) was interviewed, they confirmed that R2 was hit lightly in the forehead area after "horsing around". Resident (R2) was unable to recollect the incident. A total of six residents were interviewed, two (2) out of six (6) residents reported that R1 gets aggressive and has hit residents in the past. However, due to cognitive impairment of both, residents (R1 & R2) and sufficient staffing at the time of the incident, there is insufficient evidence to corroborate the allegation.

Based on record review and interviews conducted there is insufficient evidence to prove the allegation. 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 Administrator Diana Bautista. A copy of the report was issued.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC9099 (FAS) - (06/04)

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