306005672-3-28-2023-22-AS-SSAS-CRBNA3-20230428101649

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005672
Report Date: 03/28/2023
Date Signed: 03/28/2023 02:12:39 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
03/22/2023 and conducted by Evaluator Patricia Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230322135319

FACILITY NAME:	WELLINGTON, THE		FACILITY NUMBER:	306005672
ADMINISTRATOR:	THOMAS, JOHNATHAN		FACILITY TYPE:	740
ADDRESS:	24903 MOULTON PARKWAY		TELEPHONE:	(949) 458-2311
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	160	CENSUS: 206	DATE:	03/28/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Gerry Vadnais - Senior Executive Director Kathleen Olson - Regional Operations Specialist		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Facility is mismanaging the residents' medications
Facility is falsifying documents
Facility staff are not properly trained

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced initial 10 day complaint visit to initiate the investigation into the above allegations and to deliver the findings. LPA Velazquez was allowed entry into the facility and met with Senior Executive Director (SED) Gerry Vadnais and explained the purpose of the visit.

On today's visit LPA Velazquez conducted interviews with staff. LPA Velazquez also reviewed and obtained copies of facility, resident, and staff records. At 9:50 AM LPA Velazquez along with staff toured the Medication Room where staff described the process of medication administration to residents. During the course of the investigation the following was revealed: LPA Velazquez conducted interviews with staff. LPA also reviewed pertinent records. The records reviewed included Resident Physician's Reports, Physician's Orders listing resident medications, Medication Administration Records, a Med Tech/Nurse Med Room Duties booklet describing the medication administration process, and staff training documentation. Six of six individuals interviewed

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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-20230322135319

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: WELLINGTON, THE	FACILITY NUMBER: 306005672
	VISIT DATE: 03/28/2023

NARRATIVE

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confirmed they have not received adequate training and therefore are not properly trained. The facility did provide LPA Velazquez with some training documentation for direct care staff but the records did not reflect adequate training to meet statute and regulation. Five of six individuals interviewed confirmed medications are documented as administered when at the moment this is documented in the facility's QuickMar electronic system the medication has not actually been given to the resident to self administer. These staff indicated the facility's protocol is to pre-pour the resident medications into small envelopes where the medication then gets placed into a plastic tub. Staff then proceed to go to through the facility and locate residents to administer their medications. Staff further indicated they do not take the laptops at the time they are dispensing medications to residents so that they can document the medication administration. During the visit LPA Velazquez observed a Medication Technician with a plastic tub containing resident medications dispensing medication to a resident at the Transportation Desk where no laptop was present to document the medication administration as it was given. One individual interviewed stated a resident's medication order had not been updated in the QuickMar system and they provided the resident their Insulin pen for them to self-adminster when they were told the resident had been changed from the Insulin injectable medication to an oral medication. LPA was provided documentation indicating narcotic medications were not properly stored where they should have been as well as confirming medication records were altered to change the time a medication had been given.

Based on the observations of LPA Patricia Velazquez, interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegations: Facility is mismanaging the residents' medications, Facility is falsifying documents, and Facility staff are not properly trained are deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 and the Health and Safety Code are being cited on the attached LIC 9099D.

An exit interview was conducted with Senior Executive Director Gerry Vadnais and Regional Operations Specialist Kathleen Olson and a copy of this report along with the appeal rights and LIC 9098 were provided at the time of this visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230322135319

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: WELLINGTON, THE	FACILITY NUMBER: 306005672
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/28/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/28/2023 Section Cited CCR 87465(c)(2)	1 2 3 4 5 6 7	Incidental Medical and Dental Care. If the resident's physician has stated in writing...are met: Once ordered by the physician the medication is given according to the physician's directions. This requirement is not	1 2 3 4 5 6 7	Licensee to ensure all resident medications are administered in accordance to physician's orders. Licensee to submit a written
	8 9 10 11 12 13 14	met as evidenced by: based on record review and interview the licensee did not ensure residents' medication is given per physician's orders. This poses an immediate risk to the health and safety of residents in care.	8 9 10 11 12 13 14	statement indicating how exactly they intend to adhere to this regulation to LPA by POC due date.
Type B 04/07/2023 Section Cited HSC 1569.625(c)(4)	1 2 3 4 5 6 7	Staff training; legislative findings; contents. The training shall include, but not be limited to, the following: Policies and procedures regarding medications. This requirement is not met as evidenced by: based on	1 2 3 4 5 6 7	Licensee to ensure all staff receive training pursuant to statute and regulation and submit written proof to LPA by POC due date.
	8 9 10 11 12 13 14	record review and interview the licensee failed to ensure staff were properly trained. This poses a potential risk to the health and safety of residents in care.	8 9 10 11 12 13 14	Licensee to submit a written statement indicating how exactly they intend to adhere to this regulation to LPA by POC due date.

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 Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC9099 (FAS) - (06/04)

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