275202707-1-4-2024-24-AS-BCHN-CZLRN3-20240118120941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202707
Report Date: 01/04/2024
Date Signed: 01/04/2024 10:49:45 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/12/2023 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20231012163456

FACILITY NAME:	COTTAGES OF CARMEL		FACILITY NUMBER:	275202707
ADMINISTRATOR:	ESTRELLADO,JULIE MAY		FACILITY TYPE:	740
ADDRESS:	26245 CARMEL RANCHO BLVD		TELEPHONE:	(831) 620-1800
CITY:	CARMEL	STATE: CA	ZIP CODE:	93923
CAPACITY:	78	CENSUS: 56	DATE:	01/04/2024
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Julie May Estrellado - Executive DIrector		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff neglect resulted in worsening of resident's pressure injury.
Staff did not ensure that resident was adequately fed.
Staff did not ensure that resident was adequately hydrated.
Facility did not have sufficient staff to meet the needs of the resident.
Staff did not note changes in resident’s medical condition.
Staff did not seek resident timely medical attention.
Staff did not meet resident’s hygiene needs.
Facility did not provide a safe environment for resident.
Facility retained a resident requiring a higher level of care.

INVESTIGATION FINDINGS:

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On 1/4/2023, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with Executive Director Julie May Estrellado and announced the purpose of the inspection. The purpose of this visit is to deliver the finding of the investigation completed by the Department. LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility.
During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. The following allegations have been determined to be Unsubstantiated.

1. Staff neglect resulted in worsening of resident's pressure injury: Based off of facility skin care notes and hospice care notes, Resident 1(R1) was receiving proper skin care. R1 was receiving skin care from hospice care staff, and facility staff also regularly changed her bandage. R1 had a cellulitis wound prior to being placed in the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David Ayers	TELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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 24-AS-20231012163456

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: COTTAGES OF CARMEL	FACILITY NUMBER: 275202707
	VISIT DATE: 01/04/2024

NARRATIVE

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2. Staff did not ensure that resident was adequately fed: Based off of records review and interview, R1 received three meals a day, and was assisted with feeding if she could not eat that particular meal on her own. R1 was provided regular snacks which were documented by facility staff.

3. Staff did not ensure that resident was adequately hydrated: Facility staff documented regular checks on R1 and also maintained a hydration log. Hydration checks were conducted every two hours.

4. Facility did not have sufficient staff to meet the needs of the resident: Based on staff schedules, facility had sufficient staffing to meet the needs of their residents. In the memory care unit, there were usually 4-5 staff able to provide care to approximately 13 residents.

5. Staff did not note changes in resident’s medical condition: Staff reassessed R1 for changes in condition and communicated changes to the responsible party of R1. Staff noted any decline in R1's activities of daily living(ADL's). Facility staff held a care conference for R1 on 8/31/2023.

6. Staff did not seek resident timely medical attention: According to interviews and records, R1 did not require any acute medical attention during her stay at the facility.

7. Staff did not meet resident’s hygiene needs: Facility staff maintained a bathing and dressing log. R1 was bathed or showered approximately two times per week. Facility staff include basic grooming as part of daily ADL's.

8. Facility did not provide a safe environment for resident: Based off of inspection and observation, common areas and resident rooms were free from hazard and safe for residents.

9. Facility retained a resident requiring a higher level of care: Based off of R1's diagnosis, needs and services plan, and care assessment, facility staff were able to meet R1's care needs.

Although these 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. A copy of the report was provided to the licensee vial email and exit interview conducted.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David Ayers	TELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC9099 (FAS) - (06/04)

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