306000049-3-8-2024-22-AS-ARJR-D36QWF-20240308113153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306000049
Report Date: 03/08/2024
Date Signed: 03/08/2024 11:32:39 AM

Document Has Been Signed on 03/08/2024 11:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	HALL FAMILY HOME		FACILITY NUMBER:	306000049
ADMINISTRATOR:	RON SALDA		FACILITY TYPE:	735
ADDRESS:	1922 WEST FLORA STREET		TELEPHONE:	(714) 434-0100
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY: 6		CENSUS: 2	DATE:	03/08/2024
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	10:31 AM
MET WITH:	Diane Hall-Licensee		TIME COMPLETED:	11:00 AM

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted a office meeting to deliver findings on an investigation completed by the Department. LPA greeted and met with Licensee Diane Hall and explained the reason for the meeting. During the course of the investigation, the following deficiencies were observed and are being cited via this case management deficiency.

On 08/02/2023 Licensee Diane Hall took Client 1 (C1) to see their Primary Care Physician where they noticed C1 had pressure injuries that needed to get looked at.

C1 was taken to OC Global Medical Center. Upon being admitted, C1 was found to have multiple stage three and stage two pressure injuries including wounds on the upper right back, bilateral left and right foot and sacral area and stage two wounds on right and left gluteal area gallstones. The OC Global Medical Center wound care nurse further found scar tissue around the wounds from old healed pressure injuries resulting from infrequent repositioning. C1’s wound care nurse from OC Global Medical Center, Primary Care Physician and Dermatologist all confirmed C1’s pressure injuries were unrelated to C1’s pre-existing skin condition. Four of four caregivers confirmed providing care for C1’s wounds despite them not being a skilled trained professional.

After multiple attempts to contact Hall via phone and email, on 12/13/23 an attempted follow up visit was conducted to the facility to obtain requested documents regarding C1. During the visit Hall was asked to provide the Department with C1’s records so they can be taken for copying. Hall stated she would need to retrieve C1’s file from her Tustin Ranch Office and would produce the records by 2:40 PM that same day.

CONTINUED ON LIC809-C...

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: HALL FAMILY HOME	FACILITY NUMBER: 306000049
	VISIT DATE: 03/08/2024

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At 2:38 PM Diane reached to the Department noting she would not be able to produce the records and asked if she could overnight the records due to the size of C1’s records. Hall’s request was denied. At 4:15PM Hall met with Department staff and provided white GSO folder with a couple of documents. When asked about the multiple folders for C1 that Hall had previously reported having Hall reported the other documents were “irrelevant”.

The facility is being cited per Title 22, Division 6 of the California Code of Regulations.
An exit interview was conducted, and a copy of this report, 9099-D Page, and appeal rights at the time of exit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/08/2024 11:32 AM - It Cannot Be Edited

Created By: Alvaro Ramirez Jr. On 03/08/2024 at 10:43 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: HALL FAMILY HOME	FACILITY NUMBER: 306000049
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/08/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/11/2024 Section Cited CCR 80092.9(a)(3)	1 2 3 4 5 6 7	Wounds. The licensee ensures that a licensed professional in accordance with the physician's instructions provides the wound care. This requirement is was not met as evidence by: Licensee failed to ensure C1’s wound care was provided by a licensed professional.	1 2 3 4 5 6 7	Licensee agrees to read regulation and sign a statement of understanding and forward proof to LPA by POC due date.
	8 9 10 11 12 13 14	This poses an immediate risk to resident’s health while in care.	8 9 10 11 12 13 14
Type B 03/15/2024 Section Cited CCR80070(d)	1 2 3 4 5 6 7	Client Records. All client records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours… This requirement was not met as evidence by: Licensee failed to provide C1’s entire records as requested upon request. Licensee repeatedly delayed	1 2 3 4 5 6 7	Licensee agrees to read regulation and sign a statement of understanding and forward proof to LPA by POC due date.
	8 9 10 11 12 13 14	and made excuses for why records could not be produced. This poses a potential risk to resident’s safety while in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Sheila Santos

LICENSING EVALUATOR NAME:

Alvaro Ramirez Jr.

LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC809 (FAS) - (06/04)

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