300600816-10-3-2023-22-AS-SSAS-CWK2J4-20231012172539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300600816
Report Date: 10/03/2023
Date Signed: 10/03/2023 03:44:52 PM

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
09/27/2023 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230927122834

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: 237	DATE:	10/03/2023
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Claudia Lusca - Administrator		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Facility failed to properly assess resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint received against this facility on September 27, 2023. LPA Haley was greeted by staff and explained the reason for the visit to Administrator (AD) Claudia Lusca. During the visit LPA Haley interviewed three staff including the Administrator and went to the Memory Care unit to make some observatios.

Regarding the allegation: Facility failed to properly assess resident.

Details gathered in 3 of 3 interviews contradict the complaint allegation. It was discovered Resident 1 (R1) was assessed by Staff 1 at Kaiser Anaheim August 31, 2023. S1 noted exit seeking behavior and dementia on Rowntree Gardens New Community Member Appraisal form for R1. Due to conversations with R1's family about R1 behaviors, it was determined R1 would be placed on a two-week trial period to see if the resident would acclimate to the facility and eventually become a long term member.
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: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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 22-AS-20230927122834

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: 10/03/2023

NARRATIVE

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R1 was admitted to the facility September 5, 2023 and there was a plan in place to get the resident acclimated to the community and new surroundings. There was a staff member present in the memory care unit to redirect the resident if needed, hourly visual checks were conducted, and eventually 1 on 1 care is required if necessary.

On September 5, 2023 facility staff contacted R1's physician because R1 refused to take medication and R1's son was called as well. The residents son came to the facility (9.5.23) because R1 was having a hard time adjusting. September 6, 2023, Rowntree staff contacted R1's physician regarding medication for anxiety and restlessness. Staff also requested recommendations to deal with the residents anxiety and restlessness during the call to the physician. September 7, 2023, Rowntree staff left another message with R1's physician to request assistance because none of the previous calls were returned. On the same day (9.7.23) about 7PM, R1 was able to open an emergency exit in the memory care unit and exit the building. Alarms went off and staff followed right behind the R1 and redirected the resident back to memory care. As a result of this attempted elopement, it was determined R1 would need 1 on 1 care. R1's son was informed of this decision, and Rowntree Gardens covered the cost of the 1 on 1 care for the first day and was willing work with 1 on 1 care providers of the son's choice. September 8, 2023, a care plan meeting was held with R1's son and it was determined the facility would not be able to meet R1's needs.

Based on the information gathered during the investigation through interviews and document review, the allegation mentioned above 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: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC9099 (FAS) - (06/04)

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