306004598-2-7-2022-22-AS-MVAO-CBNQHP-20220215111125

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004598
Report Date: 02/07/2022
Date Signed: 02/07/2022 11:50:04 AM

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
10/16/2020 and conducted by Evaluator Albert Marin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201016155912

FACILITY NAME:	DELIGHTFUL LIVING		FACILITY NUMBER:	306004598
ADMINISTRATOR:	REBEKAH BUBOI		FACILITY TYPE:	740
ADDRESS:	26811 CARMENITA LANE		TELEPHONE:	(714) 600-5845
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 4	DATE:	02/07/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator Rebekah Buboi		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Resident developed a stage 1 pressure injury while in care.
Facility staff are not assisting resident with hygiene needs.
Facility staff left resident in soiled clothing for an extended period of time.
Facility staff are not dispensing resident's medication as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility. LPA met with Administrator Rebekah Buboi and stated the purpose of this visit. The purpose of this visit was to deliver the findings for the investigation conducted on the complaint that was received last October 16, 2020 against this facility.

On allegation that Resident developed a Stage 1 pressure injury in care, the following were the findings. Per file review, Resident 1 was admitted in the hospital last October 15, 2020 and was observed to have a Stage 1 pressure injury. As defined in Cleveland Clinic website, Stage 1 is discolored skin. The skin appears red in those with lighter tones and blue/purple in those with darker skin tones. The skin does not blanch (turn white) when pressed with a finger. Per physician’s report dated September 18, 2020, Resident was able to manage own toileting needs with some assistance; and with primary diagnosis of Major Neurocognitive Disorder. On the day of admission, Resident 1 was reported to be in wheelchair while taken for a walk outside the facility but was later observed to be leaning towards one side and with slurred speech. Resident was wheeled back to the facility and taken to the hospital for further evaluation and management. (Continuation in Page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert Marin	TELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022

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-20201016155912

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: DELIGHTFUL LIVING	FACILITY NUMBER: 306004598
	VISIT DATE: 02/07/2022

NARRATIVE

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(Continuation on from Page 1) File review of hospital discharge notes did not describe any care plan on Stage 1 pressure injury. Per interviews, witnesses denied having issues in the facility about meeting the incontinent care of any residents. The LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, the above allegation is deemed UNSUBSTANTIATED.

On allegation that staff are not assisting resident with hygiene needs, the following are the findings. Base on observation via video conference conducted on last October 22,2020 Residents were observed be in dressed appropriate for the weather and occasion. LPA did not observe any resident in distress during the tour. Per interviews, witnesses denied having any issue facility not meeting the hygiene needs of the resident. For this visit, LPA did a tour and observed residents were appropriately dressed and groomed. Thus, the allegation that staff are not assisting resident with hygiene needs is UNSUBSTANTIATED.

On allegation facility staff left resident in soiled clothing for an extended period of time, the following are the findings. It was reported that Resident 1 had a scheduled pick up from the facility. During the transport, R1 was observed to be soaked in urine and was on two pull up diapers. Per file review, on physician’s report dated September 18, 2020, Resident (R1) was able to manage own toileting needs with some assistance; and with primary diagnosis of Major Neurocognitive Disorder. On September 30, 2020, R1 was started on antibiotics for urinary tract infection. Facility staff frequently brought resident to the bathroom even resident did not ask. Per interview, Administrator stated on every scheduled appointment, Resident 1 was freshened up and prepared for the appointment. Per interviews, witnesses denied any issues on not meeting incontinent care needs of residents in care. During this visit, LPA conducted a tour of the facility; and did not observed offending strong odors in resident's rooms. Thus, the allegation that staff left resident in soiled clothing for extended period of time is UNSUBSTANTIATED.

On allegation that facility staff are not dispensing resident’s medication as prescribed. It was reported that during one of the visits, Resident 1 was observed slumped over and was thought that R1 was over-medicated. Per file review and interview, Resident 1 only received antipsychotic medication (Quetiapine) at nighttime. This medication has potential side effects such as dizziness and somnolence. For this visit, LPA reviewed medications with Staff 1 and did not observe discrepancy. Thus, the allegation that facility staff are not dispensing resident’s medication as prescribed is UNSUBSTANTIATED.

LPA Marin conducted an exit interview with AD Buboi and copies of this report were left in the facility.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert Marin	TELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022

LIC9099 (FAS) - (06/04)

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