306005979-6-13-2024-22-AS-AORZ-D6CNJN-20240618103037

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005979
Report Date: 06/13/2024
Date Signed: 06/13/2024 07:46:42 AM

Unsubstantiated

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
01/04/2024 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20240104163024

FACILITY NAME:	HARMONY HOME CARE		FACILITY NUMBER:	306005979
ADMINISTRATOR:	FERGUSON, KENNELLIE		FACILITY TYPE:	740
ADDRESS:	211 S ALICE WAY		TELEPHONE:	(657) 220-4800
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92806
CAPACITY:	6	CENSUS: 3	DATE:	06/13/2024
		UNANNOUNCED	TIME BEGAN:	07:10 AM
MET WITH:	Veahlou Daelto		TIME COMPLETED:	08:05 AM

ALLEGATION(S):

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Facility is improperly administering medication resulting in a resident having to be admitted to the hospital.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to deliver findings on an investigation completed by the Department. LPA was greeted and granted entry into the facility by Caregiver Arcy Vinuya and explained the reason for the visit. House Manager Veahlou Daelto was present during the visit.
During course of the investigation, the Department interviewed staff and witnesses as well as reviewed and obtained pertinent documentation including Physician Report, Resident Service Plan, and St. Joseph Hospital Medical Records. The purpose of today’s visit is to follow up on an investigation conducted by the Department regarding the above allegation. The investigation conducted revealed the following:
Resident 1 (R1) was admitted to the facility on 09/29/2021. Physician report dated September 20, 2021, notes that R1 is unable to manage their own medications.
On December 16, 2023; December 23, 2023; and December 29, 2023, R1 sustained medical emergencies requiring hospitalization related to their sodium levels which was being managed by a physician prescribed medication. CONTINUED ON LIC 9099 DATED 06/13/2024

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

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-20240104163024

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: HARMONY HOME CARE	FACILITY NUMBER: 306005979
	VISIT DATE: 06/13/2024

NARRATIVE

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Interviews with three of three staff reported that caregivers would hand resident’s their medications at the appropriate times. Staff interviewed reported they would fill out the medication forms whenever they would deliver medications to a resident. A review of R1’s medication records showed no abnormalities. An interview conducted with a medical professional who attended to R1 during one of their hospitalization's denied that low sodium levels or high doses of R1’s medication could cause seizures. When asked if there were concerns about the facility providing R1 incorrect medication dosages, they went on to say R1’s condition was very complicated, and that there were many factors contributing to it.
Although R1 sustained multiple hospitalization's while in the care of the facility, a review of records obtained and interviews conducted determined that R1’s hospitalization's were not sustained as a result of neglect by the facility staff.

Therefore, based on interviews conducted and documents reviewed, the allegation that facility is improperly administering medication resulting in a resident having to be admitted to the hospital is deemed to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted, and a copy of this report and confidential names list was left at the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

LIC9099 (FAS) - (06/04)

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