300600977-8-23-2024-22-AS-LMOA-D9M6L5-20240930205347

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300600977
Report Date: 08/23/2024
Date Signed: 08/23/2024 04:49:24 PM

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
08/13/2024 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240813123809

FACILITY NAME:	TOWN & COUNTRY		FACILITY NUMBER:	300600977
ADMINISTRATOR:	STEPHANIE JUKIC		FACILITY TYPE:	741
ADDRESS:	555 E. MEMORY LANE		TELEPHONE:	(714) 547-7581
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92706
CAPACITY:	328	CENSUS: 110	DATE:	08/23/2024
		UNANNOUNCED	TIME BEGAN:	07:20 AM
MET WITH:	Nikka Solomon, Assisted Living Coordinator		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Due to lack of staff, residents are not changed timely.
Staff do not respond to call bell in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced inspection visit to deliver findings for complaint investigation into the above allegations. LPA explained the reason for the visit with Assisted Living Coordinator Nikka Solomon.
During the course of the investigation LPA toured facility, reviewed records, conducted interviews with staff & residents, and requested pertinent documentation such as Resident Roster’s, staff roster’s, Physician’s reports, course completion records, resident care plans, and device activity reports.

During investigation LPA reviewed facility records such as Employee Handbook, staffing rosters, in service meeting notes and Device activity reports. Facility rosters revealed that facility Assisted Living has 19 staff on file per 53 residents and Memory Care Grace Gardens has 17 staff per 57 residents. Course completion records reviewed for staff revealed that all staff must complete "Abuse, neglect, and exploitation in the elder care setting training". CONTINUED ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

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-20240813123809

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: TOWN & COUNTRY	FACILITY NUMBER: 300600977
	VISIT DATE: 08/23/2024

NARRATIVE

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LPA reviewed and verified 11 employee's training was completed in this area.
Device Activity Reports for facility call buttons and pendants dated 8/13/24 and 8/22/24 revealed that 55 alarms were pulled and of the 55, 14 alarms were cleared upon departure of assisting resident rooms while remaining 41 were cleared upon arrival. Upon review facility August in service meeting dated 8/22/24 reveals training was conducted regarding pendant response time informing staff to clear pendant as soon as enter room. Training also revealed for staff to ensure to monitor pendants ideally within 10 minutes.

Interviews conducted with staff revealed that twelve of twelve staff members state they are to clear pendants and pull cords in a timely manner within 10 minutes. Staff interviews indicated that twelve of twelve staff confirm if staff member are unavailable at time call received, staff are to communicate with care team via radios so that other available staff members can assist residents. All staff interviews revealed facility has coverage of staffing to assist with residents needs. Staff interviews confirm facility uses registry for coverage.

Interviews conducted with residents revealed that eight of eight residents confirmed that staff responded to their call buttons in a timely manner of five to ten minutes. Resident interviews revealed that residents do not have issues with staff and facility has adequate staff on the floor. Five of eight residents confirmed that staff assist residents for dressing, toileting and or showering in timely manner.

Based on records reviewed and interviews conducted, although the 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 following allegations: due to lack of staff, residents are not changed timely and staff do not respond to call bell in a timely manner are deemed UNSUBSTANTIATED.

An exit interview was conducted with facility representative and a copy of this report was reviewed and provided at the time of this visit.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

LIC9099 (FAS) - (06/04)

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