300600816-10-14-2022-22-AS-MSTC-CN6Q6A-20230117105312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300600816
Report Date: 10/14/2022
Date Signed: 10/14/2022 11:35:22 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/14/2022 and conducted by Evaluator Jerome Haley

COMPLAINT CONTROL NUMBER: 22-AS-20220914145127

FACILITY NAME:	ROWNTREE GARDENS		FACILITY NUMBER:	300600816
ADMINISTRATOR:	CLAUDIA LUSCA-BORCSA		FACILITY TYPE:	741
ADDRESS:	12151 DALE STREET		TELEPHONE:	(714) 530-9100
CITY:	STANTON	STATE: CA	ZIP CODE:	90680
CAPACITY:	280	CENSUS: 169	DATE:	10/14/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	celeste gonzalez		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility failed to address resident's multiple falls.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to investigate the above complaint allegation on September 15, 2022. LPA interviewed the Administrator Claudia Lusca, several staff members, Resident 1 (R1), and her Responsible Party (RP).

The investigation into the allegation that facility failed to address resident's multiple falls revealed the following:

During the initial unannounced visit LPA Haley toured the facility and spoke with facility staff members. LPA Haley received a copy of the Fall Managment policy and during the tour observed several procedures put in place to address and pervent resident's falling. AD Lusca explained some of the procedures in the fall management policy, and explained how the Fallen Stars program works. Furthermore, interviews with staff members revealed what role each staff member plays in the execution of the fall policy. LPA interviewed S1 who explained what happens after a resident falls and and all the steps taken after the fall. For example, residents are given bells
Continued on LIC9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

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 2

Control Number 22-AS-20220914145127

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ROWNTREE GARDENS	FACILITY NUMBER: 300600816
	VISIT DATE: 10/14/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

and alarms that alert staff. LPA interviewed S2 who explained how staff are always checking on residents in addition to the hourly checks they receive. Staff constantly check on the residents and monitor them while they're in the dining room, and taking walks. Furthermore, S2 showed LPA Haley how the alarms work and explained how the alarms are placed in strategic places in the residents room like the bed, and reclining chair. LPA interviewed S3 who's stationed in the hallway and listens for bells and alarms. S3's job is to respond to the resident if a bell or alarm is heard and make sure the resident is okay. If the resident is found on the floor the next step is to call a nurse to evaluate the resident. S3 is equipped with a 2-way radio to call a nurse if needed and is not allowed to touch the resident at all.

Based on the information gathered during the investigation, observation, and review of all documents obtained, the following allegation: Facility failed to address resident's multiple falls, is deemed Unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2