306005946-5-8-2024-22-AS-AORZ-D5RU63-20240530151739

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005946
Report Date: 05/08/2024
Date Signed: 05/08/2024 01:36:21 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
05/01/2024 and conducted by Evaluator Joseph Alejandre

COMPLAINT CONTROL NUMBER: 22-AS-20240501101419

FACILITY NAME:	SERRA SOL		FACILITY NUMBER:	306005946
ADMINISTRATOR:	LINDSAY SCHROEDER		FACILITY TYPE:	740
ADDRESS:	31451 AVENIDA LOS CERRITOS		TELEPHONE:	(916) 836-8022
CITY:	SAN JUAN CAPISTRANO	STATE: CA	ZIP CODE:	92675
CAPACITY:	70	CENSUS: 44	DATE:	05/08/2024
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Lindsay Schroeder		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not prevent a resident from developing a pressure injury while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Executive Director (ED) Lindsay Schroeder and explained the reason for the visit. The investigation revealed the following. It was alleged that the staff did not prevent Resident 1 (R1) from developing a pressure injury while in care. R1 visited the hospital on April 8, 2024 and on April 13, 2024 due to falling. This information was verified through facility documents. On the hospital discharge paperwork for April 8, 2024 there is no mention of a pressure injury. The ED reported they did not receive any hospital discharge paper for the visit on April 13. The the facility notes for R1 do not mention of any pressure injuries. On April 3 the resident notes mention a red lump below the right hip and it will be monitored. On April 19 redness on the right hip area is noted and there is no wound opening. Staff interviewed reported that Home Health wound care was not ordered after either observation because the injury had not progressed to the level required for wound assistance. LPA attempted to contact the family of R1, LPA left a message but no contact was ever received. The facility notes show the staff assisted R1 with activities of daily living and provided care and supervision.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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-20240501101419

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: SERRA SOL	FACILITY NUMBER: 306005946
	VISIT DATE: 05/08/2024

NARRATIVE

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LPA reviewed R1's physician's report (LIC 602A), needs and care plan, facility notes, hospital discharge paperwork, physician's orders and emergency contact information. R1 had no physician's order to be repositioned every two hours. There is no evidence that the staff caused any injury to R1. There is no evidence to verify that R1 had a pressure injury. LPA was unable to make contact with any of the witnesses except for facility staff. Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC9099 (FAS) - (06/04)

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