306000372-6-20-2024-22-AS-SSAS-DA9VB8-20241021161708

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000372
Report Date: 06/20/2024
Date Signed: 06/20/2024 12:43:38 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
06/05/2024 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240605085654

FACILITY NAME:	ATRIA DEL SOL		FACILITY NUMBER:	306000372
ADMINISTRATOR:	GOODWIN, JEREMIAH		FACILITY TYPE:	740
ADDRESS:	23792 MARGUERITE PKWY		TELEPHONE:	(949) 458-1176
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92692
CAPACITY:	120	CENSUS: 88	DATE:	06/20/2024
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Jeremiah Goodwin		TIME COMPLETED:	01:05 PM

ALLEGATION(S):

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-Staff did not notify authorized representative of residents change in condition
-Staff left resident in soiled diapers for an extended period of time
-Staff overmedicated resident
-Staff did not notify authorized representative of new medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegation. LPA met with Jeremiah Goodwin, Executive Director.

Based on the information obtained during this investigation the department has concluded the investigation into the above mentioned allegations. Findings are based upon this investigation which included interviews conducted, tour of the physical plant of the facility and copies of pertinent documents obtained.

It is alleged that Staff did not notify authorized representative of residents change in condition. Resident (R1) file review revealed that there are resident appraisal and needs services plan for the following dates: July 28, 2021, July 25, 2021, July 29, 2021, September 12, 2021, November 21, 2021, March 6, 2022, April 6, 2022, and July 6, 2022 which have been signed by R1’s POA. Interview with 2 of 2 staff indicated that R1 did not have a change of condition, but rather had an adverse reaction to a new medication. Interview with
Continued LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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-20240605085654

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: ATRIA DEL SOL	FACILITY NUMBER: 306000372
	VISIT DATE: 06/20/2024

NARRATIVE

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staff S2 indicated that a call was made to R1’s POA when this occurred and that any time there was any adverse reaction or behavior with R1. S2 indicated that they have made those calls and indicated that R1’s POA is very involved with the care of R1 and therefore staff are very mindful of always providing information to POA.
It is alleged that staff left resident in soiled diapers for an extended period of times. LPA conducted a site visit on June 10, 2024, and was unable to make observations to R1 as R1 had moved out of the facility May 01, 2024. Interviews with 1 of 2 staff indicated that R1 could get very combative at times and did not allow for staff to give R1 proper care until R1 would calm down. Based on the information available through record review and interviews, LPA is unable to corroborate or refute that a violation occurred as alleged as the information collected is conflicting.
It is alleged that staff overmedicated resident. Records review MAR for January – May 2024 indicates that medication was given to R1 as indicated in prescription directions. MARs reflect that medication was given at the scheduled time per order indications. Interview with 1 of 2 staff revealed that medication is given as prescribed and there is no way staff can over medicate because that would cause a shortage on dosage that was needed for R1 to be given dosage as indicated per day. Staff indicated this would reflect on MAR, but however dosages are signed off as given as indicated on prescription instructions.
It is alleged that staff did not notify authorized representative of new medication. Records revealed copies of doctor’s orders for medication on file for R1, and a completed MAR sheet for all medication for resident. Interview with 2 of 2 staff revealed that they would inform POA of anything that involved R1’s care. POA was very involved with residents’ care therefore staff at facility kept POA informed of care. Staff indicated that once ordered are received by the physician the medication is given according to the physician's directions. Based on the information available through record review and interviews, LPA is unable to corroborate or refute that a violation occurred as alleged as the information collected is conflicting.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted with the Executive Director and a copy of this LIC9099 report was left at facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

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