300600816-8-28-2024-22-AS-SSAS-D8MUFS-20240830153312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300600816
Report Date: 08/28/2024
Date Signed: 08/28/2024 10:21:40 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
08/17/2021 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210817153924

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: 176	DATE:	08/28/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Stephanie Gallegos, Memory Care Director		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Resident sustained multiple falls while in care

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the allegation listed above. LPA was greeted and granted entry by front desk staff after introducing himself and stating the purpose of the visit. Memory Care Director Stephanie Gallegos was present and assisted during the visit.

The initial complaint investigation visit was conducted by LPA Ruth Martinez on August 23, 2021. During the visit, LPA conducted an interview with the facility administrator, reviewed resident records and obtained copies of pertinent documents. Additional resident records were requested from facility staff via email on August 9, 2024 and received on August 26, 2024. Additional witness interviews conducted via telephone.

Regarding the allegation that Resident sustained multiple falls while in care, the following has been concluded:
CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

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 22-AS-20210817153924

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ROWNTREE GARDENS	FACILITY NUMBER: 300600816
	VISIT DATE: 08/28/2024

NARRATIVE

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CONTINUED FROM LIC9099
Based on records reviewed and interviews conducted, it was determined that resident R1 was admitted to the facility on or around September 30, 2020. Per the physician report established upon admission, resident had an indication of dementia as well as a colostomy, was displaying confusion/disorientation and was not receiving hospice care at the time of admission. Due to an initial change in condition an updated physician report dated March 3, 2021 was established by R1's primary care physician to reflect the resident's incontinence status. Final updates were observed in August 2021 after R1 was admitted onto hospice care with a terminal diagnosis of hypertensive heart disease. The hospice admission agreement was also reviewed and indicates a date of admission of August 6, 2021. The progression of R1's condition was confirmed to have been well established and documented throughout their admission. Multiple fall episodes were confirmed to have occurred, however witness interviews established that appropriate preventative measures had increasingly been put into place, with the prescription of a hospital bed, fall pads, and culminating in the provision of a full-time one-on-one presence which was confirmed to be in effect at the time of the August fall incident.

Therefore, even though multiple falls are confirmed to have occurred, evidence gathered does not corroborate the fact that they could be attributed to negligence or failure to provide care and supervision from facility staff.

As a result, the allegation is found to be Unsubstantiated, meaning that 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.

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

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC9099 (FAS) - (06/04)

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