300600816-10-8-2021-22-AS-SSAS-C9D48F-20211203175240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300600816
Report Date: 10/08/2021
Date Signed: 10/08/2021 10:30:15 AM

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
10/01/2021 and conducted by Evaluator Kathrina Chin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211001105816

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: 182	DATE:	10/08/2021
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Claudia Lusca, ED & Celeste Gonzalez, Admin. Asst.		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Resident sustained a fall while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs), Kathrina Chin and Beverly Thompson-Gracia made an unannounced visit to the facility for the purpose of a complaint investigation. Upon arrival, LPAs met with Celeste Gonzalez, Administrative Assistant and spoke to Claudia Lusca, Executive Director on the telephone. The investigation consisted of interviews with the facility Administrator and reviewing and obtaining documentation. The following was determined:

Resident 1 (R!) fell on September 30, 2021 and sustained a hematoma to the head. Resident was sent out to UCI Medical Center and returned to the facility the same day. The reporting party indicated that the fall was unwitnessed and there was no neglect on the part of the community. LPAs interviewed Claudia Lusca, Executive Director over the telephone and she indicated that this is the first time that R 1 needed to be sent out to the hospital due to a fall. Ms. Lusca indicated that 911 emergency personnel was contacted immediately after finding the resident sustained a fall. (Continued on LIC 9099C)

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

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-20211001105816

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: 10/08/2021

NARRATIVE

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Resident 1 was seen by her primary physician on October 5, 2021 as a follow up to her fall and there were no changes made. The physician report indicated that R1's fall resulted possibly due to a stroke and hypertension.

This agency has investigated the complaint and is determined to be UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted, and a copy of this report was given to Celeste Gonzalez, Administrative Assistant.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

LIC9099 (FAS) - (06/04)

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