306005505-6-9-2021-22-AS-SSAS-C3UU23-20210610151113

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005505
Report Date: 06/09/2021
Date Signed: 06/09/2021 02:29:19 PM

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
08/06/2020 and conducted by Evaluator Michelle Reed

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200806100320

FACILITY NAME:	SELECT SENIOR CARE LLC		FACILITY NUMBER:	306005505
ADMINISTRATOR:	DATCU, DANIEL		FACILITY TYPE:	740
ADDRESS:	1221 N BIG SPRING ST		TELEPHONE:	(714) 695-9370
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92807
CAPACITY:	6	CENSUS: 5	DATE:	06/09/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator Daniel Dactu		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff caused injury to resident
Facility staff handled resident in a rough manner

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Michelle Reed conducted and unannounced visit to the facility to discuss the findings for the above allegations. Upon arrival, LPA met with Administrator Daniel Dactu. The investigation consisted of interviews with the facility staff, Administrator, and witnesses as well as documentation. The following was determined:

The Department received a complaint regarding allegations that facility staff caused injury to resident and facility staff handled resident in a rough manner.

On June 15, 2020 Resident #1(R1) was admitted into the facility. R1 was placed with Hospice services on July 02, 2020. R1 had Dementia and was given an order for full bed rails by the Hospice agency. The rails were for safety and repositioning and the facility staff were advised not to place all four rails up at one time. According to interviews with witnesses and staff, R1 would become restless while in bed and would hit her hands, legs and feet on the bed rails. This caused bruising and the Hospice agency was aware of the bruising.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

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-20200806100320

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: SELECT SENIOR CARE LLC	FACILITY NUMBER: 306005505
	VISIT DATE: 06/09/2021

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

On August 4, 2020 R1 was removed from the facility by R1’s responsible party and taken to the hospital because R1 had stated that staff were hurting R1. R1 was medically cleared at the hospital and was placed in skilled nursing. R1 did not return to the facility and passed away on August 30, 2020.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Mr. Dactu was reminded that there must always be an order for full bed rails and that a resident must be receiving hospice services in order to have full bed rails.

An exit interview was conducted with Administrator Daniel Dactu and a copy of this report was provided.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2