306003568-2-21-2023-22-AS-SSAS-CPC3Y6-20230223173924

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003568
Report Date: 02/21/2023
Date Signed: 02/21/2023 04:21:32 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
01/31/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230131073452

FACILITY NAME:	ROYALE BEST CARE HOME		FACILITY NUMBER:	306003568
ADMINISTRATOR:	LEILANI & NOLAN ALEJANDRO		FACILITY TYPE:	735
ADDRESS:	12051 GILBERT STREET		TELEPHONE:	(714) 530-8181
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY:	6	CENSUS: 3	DATE:	02/21/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Leilani Alejandro, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility retained a client with a Prohibited Health Condition

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings in the investigation of the allegation listed above. LPA was greeted and granted entry by administrator Leilani Alejandro after explaining the purpose of the visit.

An initial investigation visit was conducted on February 6, 2023. LPA reviewed records and interviewed facility administrator along with facility staff. Additional interviews were conducted with Regional Center of Orange County staff and additional records were obtained.

Regarding the allegation that Facility retained a client with a Prohibited Health Condition, the following was determined during the investigation: Following multiple reports made by client C1's Adult Day Program regarding difficulties with ambulating, client C1 was noted to have developping skin injuries on both hips.

CONTINUED ON FORM LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

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-20230131073452

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ROYALE BEST CARE HOME	FACILITY NUMBER: 306003568
	VISIT DATE: 02/21/2023

NARRATIVE

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CONTINUED FROM LIC9099

Client C1 was seen by his primary care physician on December 19, 2022 before being assessed by a home health nurse on December 29, 2022. Home Health bi-weekly intervention was started on January 2, 2023. When client C1's condition was observed by facility staff to not evolve positively, client was addressed to a wound care physician on January 25, 2023. LPA obtained and reviewed the report from the visit, which had also been made available to facility staff as well as Regional Center of Orange County staff. On this day, the wound was described in a manner consistent with a Stage 4 pressure injury, which is defined as a prohibited health condition per Section 80091(a)(4) Prohibited Health Conditions of the California Code of Regulations.

Despite the observation, facility staff did not refer client C1 to a higher level of care, as required by the regulation, until it was instructed to do so by Regional Center of Orange County staff on January 27, 2023. No records of a request for a exemption made to the Department have been found.

On the basis of records reviewed and interviews conducted, the allegation that Facility retained a client with a Prohibited Health Condition is deemed Substantiated, meaning that the preponderance of evidence standard has been met.

One deficiency is cited today per Title 22 of the California Code of Regulations.

An exit interview was conducted and a copy of the report along with appeal rights were provided to facility representative.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230131073452

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ROYALE BEST CARE HOME	FACILITY NUMBER: 306003568
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/22/2023 Section Cited CCR 80091(a)(4)	1 2 3 4 5 6 7	The California Code of Regulations Section 80091(a)(4) on Prohibited Health Conditions states that "(a) In adult CCFs clients who (...) have a health condition including (...) those specified below shall not be admitted or retained. (...)(4) Stage 3 and 4 dermal ulcers. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee to conduct a review of the applicable regulation regarding prohibited health conditions as well as to provide updated training on those regulations to caregiving staff. Documentation of the review and training to be submitted to LPA before the Plan of Correction's due date.
	8 9 10 11 12 13 14	Client was retained several days after being diagnosed with a prohibited condition. Based on records reviewed and interviews conducted, the licensee did not comply with the section cited above which poses/posed an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

LIC9099 (FAS) - (06/04)

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