306005440-9-20-2022-22-AS-AJLO-CJQVML-20220929163343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005440
Report Date: 09/20/2022
Date Signed: 09/20/2022 10:29:54 AM

Unfounded

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
09/18/2022 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220918102933

FACILITY NAME:	CARE MARSTEL 1		FACILITY NUMBER:	306005440
ADMINISTRATOR:	MARTINEZ, MINELLI		FACILITY TYPE:	740
ADDRESS:	1050 KINGSTON DRIVE		TELEPHONE:	(562) 245-6669
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	6	CENSUS: 5	DATE:	09/20/2022
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Shirley Natividad		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Facility retained a resident requiring a higher level of care.

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Administrator (AD) Shirley Natividad and explained the reason for today’s inspection. The investigation into the allegation that Facility retained a resident requiring a higher level of care revealed the following: During the course of the investigation, LPA interviewed AD and a witness and requested and reviewed the resident file for Resident #1 (R1).

It was reported that R1 was recently diagnosed with an unstageable wound and a stage 2 pressure injury. A stage 2 pressure injury is a restricted health condition and is therefore allowable, meaning the facility was able to accept R1 with this condition. An unstageable wound is a prohibited health condition and is generally not allowable without an exception or the resident being admitted to hospice. LPA interviewed AD who stated that when R1 was admitted, R1 did not have any diagnosed wounds or sores, but did have a small pink area on the backside.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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-20220918102933

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: CARE MARSTEL 1	FACILITY NUMBER: 306005440
	VISIT DATE: 09/20/2022

NARRATIVE

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A witness interviewed stated that at admission R1 had an elbow wound, but that R1’s medical providers did not give a stage or diagnosis for this wound. LPA reviewed R1’s Physician’s Report for Residential Care Facilities for the Elderly (RCFE) (LIC602A) dated 08/13/22 which does not list any diagnosed wounds, sores, or pressure injuries. AD stated that when R1 was admitted, R1 was already on hospice. AD stated that during R1’s stay at the facility, hospice provided wound care for the small pink area which developed into an open wound despite the wound care and regular turning and rotating of R1 every 30 minutes. LPA reviewed R1’s Hospice Care Notes dated from 08/18/22 to 09/02/22 which indicate that no wound was noted on R1 until 09/02/22 when hospice noted an open wound and that wound care was provided. AD stated that on 09/10/22, the wound grew rapidly and the facility called hospice who came to came to provide wound care on 09/10/22, 09/11/22, and 09/12/22. AD stated that on 09/12/22 hospice stated the wound was unstageable and that R1 had respiratory issues. On 09/12/22 R1 was taken to the hospital for respiratory issues where R1 was diagnosed with an unstageable wound. A witness interviewed corroborated AD’s statements and had no concerns about abuse or neglect and had no complaints about the facility. While R1 developed an unstageable wound at the facility, R1 was on hospice and the facility was allowed to retain R1. The facility coordinated wound care for R1, turned and rotated R1 regularly, and worked closely with R1’s family and medical providers to ensure R1 received proper care for the wound.

The Department has investigated the above allegation and found it to be Unfounded, meaning the allegation was false, could not have happened, or is without reasonable basis. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC9099 (FAS) - (06/04)

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