306004792-3-22-2021-22-AS-AORZ-BZQ2AE-20210402171327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004792
Report Date: 03/22/2021
Date Signed: 03/22/2021 03:06:47 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
09/29/2020 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20200929165524

FACILITY NAME:	FOUNTAINS AT THE SEA BLUFFS, THE		FACILITY NUMBER:	306004792
ADMINISTRATOR:	TERRY BROWN		FACILITY TYPE:	740
ADDRESS:	25421 & 25401 SEA BLUFFS DRIVE		TELEPHONE:	(949) 443-9543
CITY:	DANA POINT	STATE: CA	ZIP CODE:	92629
CAPACITY:	88	CENSUS: 61	DATE:	03/22/2021
		UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Andrea Furch		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff did not meet residents needs.
Resident developed pressure injuries due to neglect.
Resident was restrained while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman contacted the facility for the televisit via IPhone to commence the delivery of complaint findings due to COVID-19 pre-cautionary measures. LPA identified herself and discussed the reason for the call with Program Director Andrea Furch.
During the investigation, LPA interviewed staff and witnesses as well as reviewed and obtained pertinent documentation such as physician report, care plan, and hospice notes/ medication orders dated 01/04/20-09/25/2020. Regarding the allegations that staff did not meet residents needs, resident was restrained while in care, and resident developed pressure injuries due to neglect, the investigation revealed the following: Resident 1 (R1) was admitted to hospice on 01/04/2020 with a life expectancy of six months. Resident was being seen by Sea Crest Hospice four times a week on average. Hospice documentation indicates R1 was being bathed by a hospice care bath aide two times a week. Facility staff state bathing R1 in-between hospice visits as well as incontinence care being provided as often as every hour and a half. Physician report dated 08/19/2020 indicated a history of chronic urinary tract infections (UTI). Hospice documentation indicated CONTINUED ON LIC 9099C DATED 03/22/2021.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

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-20200929165524

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: FOUNTAINS AT THE SEA BLUFFS, THE	FACILITY NUMBER: 306004792
	VISIT DATE: 03/22/2021

NARRATIVE

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R1 was treated with antibiotics for a UTI on 01/24/2020, 01/27/2020, 03/20/20, and 09/22/20 as well as additional testing for a UTI on 01/17/2020,06/12/2020, and 06/25/2020. R1 had no skin integrity issues in the peri region being indicative of frequent incontinence care and cleaning. Hospice RN indicates being notified by facility staff whenever signs of a UTI were present and UTI's were treated as necessary. However, due to R1's history of UTI and decline, oral antibiotics at times were not effective.
Three out of three staff report that R1 was moved to a different room due to two water leaks occurring in the resident's room. The new room was located next to the old one. The new room had a "Jack and Jill" restroom but no shower. R1 was always bathed in the spa bath two doors down so there was not a lack in services, location or change in fees.
R1 had a documented history of vomiting thus needed to watched closely. Three out of three staff as well as hospice nurse indicate R1 would be moved from the resident's room to the common areas in the facility so the resident could be watched more closely by staff. All indicate resident would not be left in the room or bed for extended periods. Resident utilized a wheelchair and physician report dated 08/19/2020 indicated the use of the wheelchair.
Hospice documentation indicates R1 had edema in the resident's legs that was being treated. R1 had a "Scratch-like weeping skin tear" that was treated on the following dates: 09/14/2020, 09/15/2020, 09/22/2020, and 09/25/2020. Hospice nurse described the wound as a pin prick on the lower leg. Hospice RN indicates the wound is not from neglect but rather obtained due to the fragility of the leg due to edema along with R1's decline. Therefore the allegations are deemed unfounded meaning the allegations are false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with Program Director Andrea Furch and a copy of this report was provided via email and an email read receipt confirms receiving these documents.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

LIC9099 (FAS) - (06/04)

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