306005226-9-19-2023-22-AS-MSTC-CW65LE-20230929200301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005226
Report Date: 09/18/2023
Date Signed: 09/19/2023 07:49:53 AM

Unsubstantiated

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
09/14/2022 and conducted by Evaluator Lydia Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220914202228

FACILITY NAME:	ARBOR PALMS OF ANAHEIM		FACILITY NUMBER:	306005226
ADMINISTRATOR:	MARIA KAUTEN		FACILITY TYPE:	740
ADDRESS:	3411 W BALL RD		TELEPHONE:	(714) 821-9660
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	130	CENSUS: 113	DATE:	09/18/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Darlene Lindley, Acting AD		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Resident sustained pressure injury due to neglect
Failure to seek timely medical attention

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced visit to the facility to deliver findings on the above allegations. LPA identified herself and discussed the purpose of the visit with Acting Administrator Darlene Lindley. The complaint was investigated by the Department.

The investigation consisted of interviews with witnesses, residents, staff, and Medical Professionals. Facility records were obtained and reviewed as well as Medical Records from Traditions Hospice of Orange and from St. Joseph Hospital.

Resident 1 (R1) was admitted to the facility in 2013 and resided in the Memory Care unit. R1 was diagnosed with Dementia and was receiving Home Health Care with Caremore for general care. On 09/08/2022, R1 was sent to Providence St. Joseph Hospital by facility staff because it appeared R1 had stroke like symptoms.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia Martinez	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023

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-20220914202228

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: ARBOR PALMS OF ANAHEIM	FACILITY NUMBER: 306005226
	VISIT DATE: 09/18/2023

NARRATIVE

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During R1’s assessment in the Emergency Room the attending physician reported R1 having open wounds- pressure injuries and a mass peri-rectal (fistula) protruding from R1’s rectum. Attending physician conducted a complete medical examination including a CT scan to determine if R1 had a stroke. R1’s diagnoses were determined that R1 had suffered a mild stroke and R1’s fistula was malignant. The wound on R1’s shin and scalp were also cancerous.

Interview with Registered Nurse 1 (RN1) from Caremore Home Health revealed that R1 did not have pressure injuries and RN1 was overseeing R1’s cancerous lesions. Interview with Registered Nurse 2 (RN2) from Traditions Hospice revealed the R1’s peri-rectal was a large mass (tumor) on R1’s right groin area and upon R1’s return to the facility on 09/11/2022, R1 was referred to Caremore Home health for services, however, due to R1’s insurance plan, R1 was referred to Traditions Health Hospice. RN2 did not recall pressure injuries but recalls the fistula causing R1 problems. RN2 stated, Traditions nurses were sending R1’s primary care physician photos of R1’s fistula and he provided instructions to keep it clean and dry, not to cover or pack it. R1’s wound was monitored, and R1 was receiving palliative care due to R1’s decline in health. RN2 stated fistulas do not heal and the caregivers communicated well with RN2 about R1’s health or about any other resident when they had any concerns or questions. Wound care nurse from St. Joseph Hospital evaluated R1’s wounds, and reported in hospital record “peri-rectal area examined in detail, has large open wound with friable edges, with tunneling, does not appear to be pressure wound possible malignancy verses abscess” and recommended more conservative treatment and approach as this was in alignment with R1’s wishes. R1’s peri-rectal and additional areas of R1’s body including R1’s scalp had cancerous wounds. R1 received brief services from Caremore Home Health before being admitted to Providence St. Joseph’s Hospital and was discharged to the facility with Traditions Hospice for palliative care. R1’s fiduciary declined aggressive treatment for R1’s cancer, and placed R1 on palliative care. Death Certificate reported cause of disease or condition resulting in end of Stage Metastatic Rectal Cancer.

There is not enough evidence to support the allegation that Resident sustained pressure injury due to neglect because R1 had cancerous wounds. Therefore, this allegation is Unsubstantiated.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia Martinez	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20220914202228

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: ARBOR PALMS OF ANAHEIM	FACILITY NUMBER: 306005226
	VISIT DATE: 09/18/2023

NARRATIVE

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Staff 1 (S1) who was interviewed believes that R1 may have had a stroke sometime between 09/07/22 and 09/08/22 due to the symptoms R1 displayed on 09/08/22. R1 was displaying slurred speech and leaning over to one side on 09/08/22. S1 notified R1’s physician and reported concerns to the MedTech regarding R1’s stroke-like symptoms. S1 said that S1 was concerned more about R1 having a stroke and R1’s primary reason for requesting to send R1 out to the hospital. R1 was shortly admitted to the hospital that same day.

There is not enough evidence to support the allegation that facility staff failed to provide timely medical treatment due to staff responding to R1’s change of condition, calling the Physician and having R1 sent out to the hospital. Therefore, this allegation is Unsubstantiated.

There is insufficient evidence to corroborate whether the above allegations have occurred. Although the allegations may have happened or may be valid; there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Acting Administrator Lindley and a copy of this report will be sent to email on file.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia Martinez	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023

LIC9099 (FAS) - (06/04)

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