306005349-2-13-2023-22-AS-SSAS-CPH4CS-20230228175937

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005349
Report Date: 02/13/2023
Date Signed: 02/13/2023 11:04:19 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
04/23/2021 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210423080836

FACILITY NAME:	LAS PALMAS		FACILITY NUMBER:	306005349
ADMINISTRATOR:	MONICA CASTILLO		FACILITY TYPE:	740
ADDRESS:	24962 CALLE ARAGON		TELEPHONE:	(949) 586-3393
CITY:	LAGUNA WOODS	STATE: CA	ZIP CODE:	92637
CAPACITY:	220	CENSUS: 136	DATE:	02/13/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Monica Castillo		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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-Staff did not seek timely medical attention for resident in care

-Resident was left unsupervised with markers and colored pencils resulting in the resident using the marker as make-up on face

-Staff could not find DNR to give it to medical personnel

-Staff are over medicating resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegations. LPA arrive at facility was greeted by the receptionist and granted entry. LPA spoke with Monica Castillo, Administrator and explained the purpose of the visit.

Findings are based upon this investigation which included interviews conducted, physical plant of facility observations and review of records.

It is alleged that staff did not seek medical attention for resident in care. Per records review resident (R1) on 04/19/2021 at 2:30pm was observed by staff (S3) resident sleeping in the theater room. S3 and staff (S4) therefore transferred resident onto a wheelchair and brought resident back to their bedroom and was transferred into bed. R1 was observed to be in a deep sleep and appeared weak and lethargic. R1’s daughter tried to wake
Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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-20210423080836

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LAS PALMAS	FACILITY NUMBER: 306005349
	VISIT DATE: 02/13/2023

NARRATIVE

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resident and was ineffective in doing so. Staff (S2) was notified and staff came to check on residents’ vitals. S3 immediately called 911 to have paramedics come to the community to transport resident to hospital for medical attention.

It is alleged that resident was left unsupervised with markers and colored pencils resulting in the resident using the marker as a mark-up on face. LPA on site visit 05/03/2021 inspected R1’s apartment and observed there to be no markers or colored pencils within the vicinity of the apartment. LPA inspected the craft room and observed craft supplies in storage, however there was no markers or colored pencils in sight. Interviews with staff revealed that R1 has not been observed to having marking in the face area at any time while at the community. However, staff did indicate that R1 has the habit of putting markers or colored pencils while doing craft to try and later use then as make up. Staff indicated that since they know this is a pattern, they always check resident to make sure they have no markers or colored pencils in their possession. Records review indicated that staff informed daughter of R1 on 04/23/2021 of the issues with markers and colored pencils when daughter asked staff about it. Staff indicated on progress notes for 04/23/2021 that resident has tried on multiple occasions and when interviewed staff indicated R1 has never been successful in writing on her face because markers or colored pencils have been taken from R1 on every occasion.

It is alleged that staff could not find the DNR to give to medical personnel. Interviews with S1 revealed that facility does not have a DNR however we have an Advance health care directive and that was provided which outlines the healthcare wishes page 2 & 3 of the documents. Interview with S1 and S2 revealed that a copy of the advanced health care directive was provided to paramedics with the 911 packet. File review reveals that the advanced health care directive on page 2 number 6 instructions for health care as it would for a DNR.

It is alleged that staff are over medicating resident. Records review MAR for Mar – May 2021 indicates that medication was given to R1 as indicated in prescription directions. Records are noted that medication was not given on April 19-21, 2021 due to R1 being admitted to hospital and was away from the facility. Thru the course of March – May there has been 5 medications that have been stopped per indications of doctor. Interview with S2 revealed that medication is given as prescribed and there is no way staff can over medicate because that

Continued on LIC9099-C

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20210423080836

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LAS PALMAS	FACILITY NUMBER: 306005349
	VISIT DATE: 02/13/2023

NARRATIVE

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would cause a shortage on dosage that is needed for R1 to be given dosage as indicated per day. S2 indicated this would reflect on MAR, but however dosages are signed off as given as indicated on prescription instructions.

Based on the information mentioned above, 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 evidence to prove or refute the alleged violation occurred; therefore, these allegations are deemed Unsubstantiated.

An exit interview was conducted with Administrator and a copy of this LIC9099 report was left at facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC9099 (FAS) - (06/04)

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