306005260-7-23-2021-22-AS-MSTC-C5EULV-20210730154123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005260
Report Date: 07/21/2021
Date Signed: 07/23/2021 10:54:36 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
06/17/2020 and conducted by Evaluator Shobhana Frank

COMPLAINT CONTROL NUMBER: 22-AS-20200617112242

FACILITY NAME:	COAST SENIOR CARE		FACILITY NUMBER:	306005260
ADMINISTRATOR:	VIANA, KRISTEN		FACILITY TYPE:	740
ADDRESS:	22201 CAPE MAY LANE		TELEPHONE:	(714) 377-0638
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92646
CAPACITY:	6	CENSUS:	DATE:	07/21/2021
		UNANNOUNCED	TIME BEGAN:	01:18 PM
MET WITH:	Care staff Mitzi Avena		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident's needs were not being met
Resident was denied visitors
Resident was rough handled by staff
Staff refused to give resident their personal belongings upon discharge

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Shobhana Frank made an unannounced visit to deliver findings on the above allegation. LPA Frank met with care staff Mitzi Avena and explained the reason for the visit.

During the investigation LPA Frank conducted FaceTime Virtual visit with Administrator Kristen Viana on 06/22/20. LPA Frank interviewed Licensee, Staff 1 (S 1), R 1, R 2, obtained and reviewed Physician reports dated 6/27/2018 and 7/11/2019. Admission Agreement dated 6/20/2018, Incident Report dated,12/19/19,1/10/2020,5/2/2020,6/17/2020, FAX notes dated 6/1/2020,6/17/2020,6/20/2018, Progress Notes from 6/20/18 to 6/17/20, Appraisal/Needs And Services Plan dated 6/21/18,text message with the residents photos - dated 12/6/2018 to 6/15/19, the facility file, facility personnel summary report, client roster. LPA interviewed R1’s responsible party.
The investigation into above allegations revealed the following:
On Allegation Resident's needs were not being met.
Based on review of documents and staff interview reveled that Administrator, Kristen Viana more than 40 hours at the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Shobhana Frank	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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 2

Control Number 22-AS-20200617112242

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: COAST SENIOR CARE	FACILITY NUMBER: 306005260
	VISIT DATE: 07/21/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Staff and resident interviews confirmed resident’s hygiene needs were met. Staff and witnesses interviewed along with LPA's observations made on 6/22/20 confirmed resident 1 (R 1) was provided clean linens and supplies of incontinence care products were in adequate amounts for the number of residents in care. Resident is on hospice care. Administrator’s interview revel that (R 1)’s fingernails were long and were filed by care giver. Because of Parkinson’s disease R 1’s hand become completely contracted it was hard for care staff to cut his nails. Family was aware of the problem. (R 1) had great care, (R 1) and caregiver (S 1) were friends, they would go on walks and (S 1) would show him pictures and videos and play reggae music for him. (R 1) and staff had a great relationship.
On Allegation Resident was denied visitors.
Interviews of staff reveled that family kept trying to come in during the high peak of Covid and AD worked with the family getting ( R 1) to the window so they could visit. All residents were being offered facility phone if they do not have their own phone. Residents were actively participating in zoom/ FaceTime as well. The visitor’s policy is posted at the entrance of the facility.
On Allegation Resident was rough handled by staff.
Per facility documentation, and interview of resident 1 (R1) resident 2 (R 2) Staff 1(S1) Staff 2 (S 2) reveled that the staff is very gentle and has never been rough with the residents. They deny seeing the resident was being rough handled and jerked around by staff in his wheelchair. There has not been inappropriate behavior or comments and is happy to have assist the resident.
On Allegation Staff refused to give resident their personal belongings upon discharge.interviews of staff and Administrator reveled that when the family attempted to remove resident's personal belongings the family was told by the caregiver; they could not take resident's hospital bed because that bed was belong to the facility. The facility had provided the bed that was originally purchase by the family which was used by resident when he was residing at her Garden Grove home first and stayed for almost a year. The bed was stored in the garage. The conflicting information received from interviews regarding Staff refused to give resident their personal belongings upon discharge LPA is unable to determine if the alleged violations occurred as reported.
Based on the information gathered during the investigation the department 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 allegations Resident's needs were not being met, Resident was denied visitors, Resident was rough handled by staff and Staff refused to give resident their personal belongings upon discharge are deemed unsubstantiated.
Exit interview conducted and copy of report provided.

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Shobhana Frank	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2