306004415-3-7-2024-22-AS-SSAS-D36SJ7-20240308125441

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004415
Report Date: 03/07/2024
Date Signed: 03/07/2024 11:47:55 AM

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
07/17/2023 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230717160505

FACILITY NAME:	SEASIDE TERRACE RETIREMENT COMMUNITY		FACILITY NUMBER:	306004415
ADMINISTRATOR:	KAROLINA FIL		FACILITY TYPE:	740
ADDRESS:	9925 LA ALAMEDA AVENUE		TELEPHONE:	(714) 962-5531
CITY:	FOUNTAIN VALLEY	STATE: CA	ZIP CODE:	92708
CAPACITY:	0	CENSUS: 0	DATE:	03/07/2024
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:			TIME COMPLETED:	11:27 AM

ALLEGATION(S):

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Resident sustained pressure injuries in care due to staff neglect.

INVESTIGATION FINDINGS:

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The facility is closed and no longer operating so the LIC 9099 is being sent to the address on record for the Licensee via mail (United States Postal Service).

The investigation into the allegation, resident sustained pressure injuries in care due to staff neglect revealed the following. It was reported that Resident 1 (R1) had 2 unstageable pressure injuries in the sacrum area which were caused by staff neglect. R1 was admitted to home health on May 4, 2023, for cancer, Parkinson’s disease, and muscle weakness. R1 was visited by Home Health nurses twice a weak. A review of R1’s Vista Home Health records shows R1 developed pressure injuries on or around May 31, 2023. The Home Health physician ordered a wound care nurse to treat R1 once a week for their pressure injuries. R1 was visited for wound care on June 9, 2023, June 16, June 23, 2023, June 30, 2023 and July 7, 2023. The Administrator reported that staff followed the directions of Home Health and took proper care of R1 which included rotating R1 every 2 hours.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

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-20230717160505

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: SEASIDE TERRACE RETIREMENT COMMUNITY	FACILITY NUMBER: 306004415
	VISIT DATE: 03/07/2024

NARRATIVE

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The facility did not keep any rotation schedule log. Staff 1 (S1) and Staff 2 (S2) reported they rotated R1 every 2 hours and followed the care plan and directions of the Home Health Physician. Staff 3 (S3) reported that they were instructed to contact Home Health if there were any issues with R1 pressure injuries. S3 reported they didn’t notice any changes or issues with R1’s pressure injuries. The Home Health company had R1 transported to Fountain Valley Hospital on July 12, 2023, because of general weakness, hypoxia and their pressure injuries were not healing as expected. R1 was hospitalized from July 12, 2023 to July 18, 2023 and returned to the facility on July 19, 2023. Upon R1’s admission to the hospital their Home Health order was terminated. On July 19, 2023, R1 was discharged from the hospital and was admitted to St. Liz Hospice for cancer, Parkinson’s disease, and pressure injuries. Hospice Nurse reported that they provided showers to R1 twice a week and there were no issues with the facility staff not providing care. A review of St. Liz Hospice records shows hospice nurse visited R1 on July 19, 2023, July 21, 2023 and August 4, 2023 to treat R1, including their pressure injuries. The Administrator reported that on August 14, 2023, R1 was placed on daily Hospice visits due to their declining condition. R1 passed away on August 16, 2023. The death certificate for R1 lists cardiac arrest as the cause of death. R1 developed pressure injuries on or around May 31, 2023, and Home Health had a nurse provide wound care after the injuries were discovered. Staff reported they cared for R1 in accordance with Home Health orders. When R1’s pressure injuries did not heal as expected R1 was hospitalized and upon their discharge was placed on Hospice. Hospice providers attended to R1 with regular visits until their passing on August 16, 2023.

Based on the evidence gathered the allegation, resident sustained pressure injuries in care due to staff neglect is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The LIC 9099 and LIC 9099C are being sent to the last known address of the Licensee via mail (United States Postal Service).

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC9099 (FAS) - (06/04)

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