306005349-12-5-2023-22-AS-SSAS-CYK2ZG-20231215165015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005349
Report Date: 12/05/2023
Date Signed: 12/05/2023 01:47:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
09/20/2021 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210920105558

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:	0	CENSUS: 160	DATE:	12/05/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Monica Castillo		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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-Staff failed to supervise resident resulting in multiple falls and injuries.

-Facility is understaffed.

-Resident's care needs are not being met.

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 failed to supervise resident resulting in multiple falls and injuries. Per records review resident (R1) on 08/21/2021 was reassessed for Morse Fall scale. Facility placed R1 on an implementation high risk fall prevention intervention and placed on routine checks. Progress notes revealed notes about the routine checks done by staff and notes indicate on various occasions R1 was not using walker to aid with fall

Continued on LIC809-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: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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-20210920105558

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LAS PALMAS	FACILITY NUMBER: 306005349
	VISIT DATE: 12/05/2023

NARRATIVE

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prevention. Unusual incident reports received after R1’s fall assessment indicate that R1 had two fall incidents. Incident reports indicate the walker for assistance was not used by R1 as should had been used to aid in fall prevention. Progress notes revealed that facility staff were proactive in ensuring R1 is always using the walker.

It is alleged that the facility is understaffed. Title 22 regulation states: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. An interview with facility staff revealed that memory care unit census at the time of incident was 20. Records review revealed that the facility had three shifts; AM Shift, PM shift and NOC shift. The facility schedule indicates that there were three staff per Am and PM shift per day and two staff NOC shift per day.

It is alleged that residents’ care needs are not being met. LPA facility visit on 09/27/2021 while conducting physical plant inspection observed R1’s bedroom and noted that walker was within reach and on site of R1. Records review revealed that on various dates from 03/02/2021 – 09/20/2021 R1 would refuse to use the walker for assistance. Notes indicate facility staff would ensure that R1 would always use the walker and remind R1 about using the walker for ambulation assistance. Notes indicate that R1 refused to use a walker and/or a wheelchair for assistance when ambulating. Records review revealed that R1 was on a routine check basis and staff would have to remind R1 as well as redirect R1 throughout the day on a normal basis.

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: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC9099 (FAS) - (06/04)

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