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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005505
Report Date: 04/19/2022
Date Signed: 04/19/2022 12:08:37 PM

Substantiated


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
07/22/2021 and conducted by Evaluator Michelle Reed
COMPLAINT CONTROL NUMBER: 22-AS-20210722114338
FACILITY NAME:SELECT SENIOR CARE LLCFACILITY NUMBER:
306005505
ADMINISTRATOR:DATCU, DANIELFACILITY TYPE:
740
ADDRESS:1221 N BIG SPRING STTELEPHONE:
(714) 695-9370
CITY:ANAHEIMSTATE: CAZIP CODE:
92807
CAPACITY:6CENSUS: 6DATE:
04/19/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Daniel Dactu and Carmen Daraban TIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff did not seek medical attention timely
INVESTIGATION FINDINGS:
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Licensing Program Analyst Michelle Reed arrived at the facility to deliver findings of this complaint.Upon arrival, LPA met with Carmen Daraban. Administrator Daniel Dactu was grocery shopping and arrived a short while later. The investigation consisted of interviews with Administrator, staff and witnesses as well as documentation. Resident #1(R1) was not interviewed due to his diagnosis or cognitive skills. The following was determined:

R1 was admitted into the facility on 7/8/21. According to records reviewed, R1 needed maximum assistance and two people to transfer. He was unable to make his needs known due to his diagnosis and required assistance with all Activities of Daily Living. Upon arrival to the facility interviews disclosed that R1 was very stiff and had pain in his right leg and shoulder. R1 was assisted to the restroom by two staff. Staff #1 stood by as R1 had a habit of trying to get up from the toilet. According to staff, R1 continued having pain during transfers and changing. Medical attention was not sought by staff or the POA. On 7/17/21 R1's POA contacted 911. R1 was diagnosed with a hip fracture.
(Continued)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
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 3
Control Number 22-AS-20210722114338
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: 04/19/2022
NARRATIVE
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Based upon interviews and documentation, the preponderance of evidence standard has been met and the above allegations are substantiated.

See attached LIC9099D for cited deficiencies per California Code of Regulations, (Title 22, Division 6, Chapter 8).

An exit interview was conducted and a copy of this report and appeal rights were provided to Daniel Dactu.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 22-AS-20210722114338
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/20/2022
Section Cited
CCR
87465(g)
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Incidental Medical and Dental Care-The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis.
This requirement was not met as evidenced by:
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Licensee understands that it is his responsibility to ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided to meet the residents needs. Licensee agrees to provide proof of understanding of Section 87465 in writing by 4/20/22.
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On 7/8/21 Licensee noted that R1 had pain in his right leg and shoulder. Responsible party was made aware. Licensee failed to seek medical treatment or contact 911. R1's responsible party contacted 911 on 7/17/21. R1 was diagnosed with a hip fracture.
This poses an immediate health and safety risk as well as personal rights risk to residents.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3