306000502-10-31-2020-22-AS-LADS-BUYMTA-20201102085312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000502
Report Date: 10/31/2020
Date Signed: 10/31/2020 02:44:59 PM

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
05/04/2020 and conducted by Evaluator Patricia Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200504142546

FACILITY NAME:	NEW HORIZON LODGE, INC.		FACILITY NUMBER:	306000502
ADMINISTRATOR:	GLEN E GOLDSMITH		FACILITY TYPE:	740
ADDRESS:	8541 CERRITOS AVENUE		TELEPHONE:	(714) 821-5781
CITY:	STANTON	STATE: CA	ZIP CODE:	90680
CAPACITY:	120	CENSUS: 75	DATE:	10/31/2020
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Mark Milanes - L.V.N.		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Resident sustained a fracture while in care
Staff failed to seek timely medical attention for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Patricia Velazquez conducted a subsequent complaint tele-visit due to the COVID-19 Pandemic and precautionary measures. LPA Velazquez spoke with Mark Milanes, L.V.N., identified herself, and discussed the above allegations. The purpose of this visit was to deliver the findings of the above allegations investigated by the Department.

During the investigation interviews were conducted with Resident (R) #1’s family members, facility staff, Anaheim Global Medical Center Social Worker, and R1’s Hospice physician. Facility records were obtained for R1 as well as medical records from Anaheim Global Medical Center, Compassionate Care Cancer Medical Group, and Los Robles Healthcare Hospice agency. The New Horizon Lodge, Inc. records for R1 included an Admission Record, Individualized Service Plan, Physician’s report including a primary diagnosis of Dementia and a secondary diagnosis of Cellulitis of Right Upper Limb. The Los Robles Healthcare Hospice records for R1 indicated that the resident was referred for hospice. Hospice records indicated facility staff contacted

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (714) 380-0440
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2020

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-20200504142546

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: NEW HORIZON LODGE, INC.	FACILITY NUMBER: 306000502
	VISIT DATE: 10/31/2020

NARRATIVE

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hospice on 4/26/2020 to report that R1’s right thigh was swollen and warm to the touch. A hospice nurse visited the facility on 4/26/2020 to evaluate R1 where it was documented “checked and assessed note right thigh was swelling, warm to touch and unable to move due to pain.” The hospice nurse then contacted the hospice physician as well as the family representative. The Dr. ordered X-rays for R1 which were performed on 4/30/2020. Los Robles Healthcare Hospice records documented nurses and aides conducted several visits to the facility to evaluate R1 from 4/26/2020 – 4/30/2020. The documentation reported on 4/28/2020 and 4/30/2020 “patient has no pain, or pain does not interfere with activity.” X-rays were performed on R1 on 4/30/2020 which revealed a Right Femur Fracture and R1 was then transported via ambulance to Anaheim Global Medical Center for further evaluation and treatment. X-rays were also taken at the hospital and the Radiology Department Findings indicated, “five total views show diffuse osteopenia and recent medially displaced and angulated mid and distal femoral diaphyseal spiral fracture.” R1 was admitted to the hospital and underwent further treatment and testing. The Compassionate Cancer Care Medical Group records dated 7/16/2019 revealed “Breast Cancer Stage IV, Bone Lesions in skull and spine, and innumerable bone mets including ribs, spine, pelvis, and right femur.” R1 was released from Anaheim Global Medical Center on 5/5/2020 to a Skilled Nursing Facility (SNF) for further rehabilitation and physical therapy.
The interviews conducted and the records reviewed indicated the facility contacted Los Robles Hospice on 4/26/2020 after observing R1’s swollen right thigh. A hospice nurse then contacted the hospice Dr. on 4/26/2020, who ordered x-rays. Due to COVID-19 x-rays were not performed until 4/30/2020. Upon learning R1 had a right femur fracture, the Dr. referred R1 to the hospital for further evaluation and treatment. The medical records documented R1’s possible pathologic fracture of the right femur as R1’s breast cancer had metastasized to several osseous regions including the right femur. Therefore, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Consequently, the following allegations: Resident sustained a fracture while in care and Staff failed to seek timely medical attention for resident are both deemed UNSUBSTANTIATED.

An exit phone interview was conducted with Mr. Mark Milanes, L.V.N. and a copy of this report was signed by LPA Patricia Velazquez. The report along with the appeal rights and LIC 811 will be sent via email to Administrator Glen Goldsmith who agrees to sign and date the report. This report was sent via email and an electronic read receipt confirms receiving the report. Administrator Glen Goldsmith agrees to send the original report by mail to the CCLD Regional Office (RO) in Orange.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (714) 380-0440
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2020

LIC9099 (FAS) - (06/04)

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