306005334-12-2-2022-22-AS-SSAS-CM42RB-20221213163717

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005334
Report Date: 12/02/2022
Date Signed: 12/02/2022 10:50:01 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
01/18/2022 and conducted by Evaluator Kathrina Chin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220118151938

FACILITY NAME:	WONDER'S YEARS		FACILITY NUMBER:	306005334
ADMINISTRATOR:	JUAN M. GARCIA TRUJILLO		FACILITY TYPE:	740
ADDRESS:	24301 BARK STREET		TELEPHONE:	(949) 215-4087
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	6	CENSUS: 2	DATE:	12/02/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Juan Trujillo, Administrator		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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1) Staff were not adequately assisting the resident with the administration of medications.
2) Staff is using restraints on a resident.
3) Staff offered medication to authorized representative for resident that was not ordered by the doctor.
4) The owner did not terminate the contract upon death of the resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kathrina Chin conducted an unannounced visit for the purpose of delivering the findings on a complaint investigation. LPA Chin met with Administrator, Juan Trujillo.

During the investigation of the above allegations, LPA Chin interviewed staff, witnesses as well as reviewed and obtained pertinent records.

It was alleged that facility staff was not dispensing Morphine per doctor's orders to R1 who was on hospice care. LPA Chin interviewed S1 and S2 who stated that Morphine was given at approximately 9:30 AM on January 5, 2022. The family members of R1 arrived at approximately 10 AM. R1's family requested for additional Morphine to be given to R1. However, S1 explained to R1's family members that he has just administered Morphine to R1. R1's family members did confirm that S1 showed them the bottle of Morphine and that S2 told them that he needs to follow the instructions from the doctor and nurses of the hospice agency. (Continued on LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022

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-20220118151938

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: WONDER'S YEARS	FACILITY NUMBER: 306005334
	VISIT DATE: 12/02/2022

NARRATIVE

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The hospice nurse arrived soon after and administered the Morphine medication. LPA Chin reviewed the hospice medication list which indicates that Morphine is to be given every two hours as needed.

It was alleged that R2 was restrained with a belt on her wheelchair. LPA Chin has visited the facility on two occasions. On both visits, R2 was not restrained and was observed sitting in the dining table without a wheelchair. LPA Celine De Perio has visited the facility and stated that she has not observed R2 to be restrained on her wheelchair. LPA attempted to interview R2 but was unable due to cognitive impairment. S1 and S2 stated that R2 has never been restrained. R2 is on hospice care since July 27, 2021.

It was alleged that S1 offered the responsible party of R1 medication for R1 that was not ordered by the doctor in order to help R1 sleep better. LPA interviewed S1 and he denied that he ever offered any medication to help the resident sleep better. S1 said that he only gives his residents medications that their doctors have ordered. LPA interviewed S2 and she said she passes out medications only ordered by the resident's doctors and nothing more.

R1 moved into the facility on December 30, 2021 and moved out on January 5, 2022. R1's responsible party did not provide a thirty day notice. S1 stated that the hospice agency nurse informed him of R1's moving out of the facility the same day that R1 moved out. S1 had no prior knowledge. R1's responsible party signed a document that they were moving R1 out of the facility on January 5, 2022 and there would be no refund.

Based on the information gathered during the investigation and review of all documents obtained, the following allegations: Staff were not adequately assisting the resident with the administration of medications, Staff is using restraints on a resident, Staff offered medication to authorized representative for resident that was not ordered by the doctor, The owner did not terminate the contract upon death of the resident are deemed Unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted, appeal rights explained and provided. A copy of this report was provided during the visit to Juan Trujillo, Administrator.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022

LIC9099 (FAS) - (06/04)

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