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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005211
Report Date: 11/30/2023
Date Signed: 11/30/2023 11:29:47 AM

Substantiated


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
02/08/2023 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20230208145448
FACILITY NAME:ARDENT CAREFACILITY NUMBER:
306005211
ADMINISTRATOR:MELINDA FLORESFACILITY TYPE:
740
ADDRESS:1665 SOUTH BROOKHURST STREETTELEPHONE:
(714) 991-0991
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:27CENSUS: 22DATE:
11/30/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Melinda Flores- Administrator TIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Lack of care and supervision from the facility's staff resulted in untimely medical attention for resident who sustained injuries.
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by Melinda Flores, Administrator and explained the reason for the visit.

The Department received a complaint on 02/08/2023 and LPA Mendivil conducted an initial visit on 02/09/2023. During the visit LPA Mendivil reviewed documents including physician’s reports, assessments, staff schedules and admission agreements. Regarding the allegation Lack of care and supervision from the facility's staff resulted in untimely medical attention for resident who sustained injuries., the investigation revealed the following:

On 01/23/2023 Resident 1 (R1) was assessed by Administrator Melinda Flores at the facility. Based on interviews with Administrator Melinda it was reported that R1 had previous falls prior to moving into Ardent Care.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 22-AS-20230208145448
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: ARDENT CARE
FACILITY NUMBER: 306005211
VISIT DATE: 11/30/2023
NARRATIVE
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R1 was admitted into the facility on 2/1/23. Throughout R1’s stay at the facility multiple staff interviewed observed R1 wandering throughout the facility and had to be redirected, 5 out of 7 staff observed R1 dancing to music in her room. The remaining 2 staff members had no direct knowledge of R1’s initial demeanor. R1’s roommate indicated R1 was up all hours of the night. R1’s roommate stated that R1 would pace back and forth and would go through roommate’s dresser and remove roommates’ clothes.

Based on R1’s physician’s report (LIC 602) dated 5/19/2022, R1’s primary diagnosis is dementia with behavioral disturbances and is noted to have aggressive behaviors with sundowning and was confused and disoriented.

On 02/6/2023 R1s family visited R1 for the first time since moving in, and they found R1 in a wheelchair and was told by staff that R1 could not stand for long period of time. It was reported by staff that R1 was asked if they had fallen and R1 stated “no”. R1 began to complain of pain when assessed by staff and responsible party when left hip was touched. It was noted R1 was sent to UCI Hospital at 10:40am where they were diagnosed with a fractured pelvis.

It was noted by staff in Services Notes on 02/05/2023 at 7am that R1 complained of pelvic, left leg and lower back pain. Based on Service Notes, staff noted R1 was placed in a wheelchair and 911 was not called. It was reported family was not notified until the incident on 02/06/2023.

Per California Assisted Living Waiver Individual Service Plan (ALW ISP) dated 8/18/22 R1 requires reinforcement of safety precautions due to being a fall risk and requires assistance with mobility/ambulation. Based on ALW ISP R1 has a history of behaviors due to Alzheimer’s, R1 has a history of wandering behaviors. Based on hospital intake paperwork dated 02/06/2023 there was noted bruising on R1’s left hip and pelvis region. Per review of R1’s Admission Agreement dated 02/01/2023, it was noted that R1 would need assistance with dressing, reminders for eating, toileting, bathing, and grooming. Based on service notes R1 was noted to be placed in a wheelchair on 02/05/2023 at 7 am which would mean the resident was presenting with pain for at least 24 hours prior to be taken to the hospital.

A civil penalty is pending determination, per H&S Code Section 1569.49(e).

Based on the preponderance of evidence through record review and interviews the allegation Lack of care and supervision from the facility's staff resulted in untimely medical attention for resident who sustained injuries. is SUBSTANTIATED, meaning the complaint allegation is valid and that a violation has occurred.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 22-AS-20230208145448
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: ARDENT CARE
FACILITY NUMBER: 306005211
VISIT DATE: 11/30/2023
NARRATIVE
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The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8 and civil penalties assessed.

An exit interview was conducted and a copy of this report and appeal rights was provided to the Administrator.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 22-AS-20230208145448
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: ARDENT CARE
FACILITY NUMBER: 306005211
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/01/2023
Section Cited
CCR
87464(f)(1)
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(f) Basic services shall at a minimum include:
(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).
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Licensee to
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This requirement was not met as evidence by resident was noted as a fall risk and resident was left in wheelchair due to pain for over 24 hours. This poses an immediate risk to health and safety to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
02/08/2023 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20230208145448

FACILITY NAME:ARDENT CAREFACILITY NUMBER:
306005211
ADMINISTRATOR:MELINDA FLORESFACILITY TYPE:
740
ADDRESS:1665 SOUTH BROOKHURST STREETTELEPHONE:
(714) 991-0991
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:27CENSUS: 22DATE:
11/30/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Melinda Flores- Administrator TIME COMPLETED:
10:55 AM
ALLEGATION(S):
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2
3
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9
Facility restricted a resident's ability to receive visitors
Facility failed to report a serious incident involving a resident to the Responsible Party
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by Melinda Flores, Administrator and explained the reason for the visit.

The Department received a complaint on 02/08/2023 and LPA Mendivil conducted an initial visit on 02/09/2023. During the visit LPA Mendivil reviewed documents including physician’s reports, assessments, staff schedules and admission agreements. Regarding the allegation Facility restricted a resident's ability to receive visitors and Facility failed to report a serious incident involving a resident to the Responsible Party, the investigation revealed the following:

On 01/23/2023 Resident 1 (R1) was assessed by Administrator Melinda Flores at the facility. Administrator noted that R1 had previous falls prior to moving into Ardent Care. R1 was admitted into the facility on 2/1/23.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 22-AS-20230208145448
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: ARDENT CARE
FACILITY NUMBER: 306005211
VISIT DATE: 11/30/2023
NARRATIVE
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It was reported by Administrator Melinda Flores that she suggests as a best practices to families to allow time for the resident to acclimate to the facility prior to visiting in person and not as instructions or rule. Based on interviews with R1’s family they followed the administrator’s advice.

Based on R1’s physician’s report (LIC 602) dated 5/19/2022, R1’s primary diagnosis is dementia with behavioral disturbances. It was reported by facility that on 2/6/2023 R1s family visited R1 for the first time since moving in, and they found R1 in a wheelchair and was told by staff that R1 could not stand for long period of time. R1 was asked if they had fallen and R1 stated “no”. R1 began to complain of pain when assessed by staff and responsible party when left hip was touched. R1 was sent to UCI Hospital where they was diagnosed with a fractured pelvis.

It was noted by staff in Services Notes on 02/05/2023 at 7am that R1 complained of pelvic, left leg and lower back pain. R1 was placed in a wheelchair and 911 was not called. It was reported family was notified on 02/06/2023, when the administrator was made aware of the issue.

Based on the preponderance of evidence through interviews and records reviewed the allegations that Facility restricted a resident's ability to receive visitors and Facility failed to report a serious incident involving a resident to the Responsible Party are determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. This agency has investigated this complaint.

No deficiencies cited.

An exit interview was conducted and a copy of this report and confidential names list was provided.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6