331800160-12-16-2024-18-AS-TDAN-DC5W4U-20241220155807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800160
Report Date: 12/16/2024
Date Signed: 12/16/2024 09:57:03 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/09/2024 and conducted by Evaluator Janette Romero

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240809151239

FACILITY NAME:	HIGHGATE SENIOR LIVING-TEMECULA		FACILITY NUMBER:	331800160
ADMINISTRATOR:	WILLIAMS, KATHLEEN		FACILITY TYPE:	740
ADDRESS:	42301 MORAGA ROAD		TELEPHONE:	(951) 308-1885
CITY:	TEMECULA	STATE: CA	ZIP CODE:	92591
CAPACITY:	99	CENSUS: 85	DATE:	12/16/2024
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Administrator, Ricardo Gomez		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

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Staff are not administering medication(s) to resident according to physicians instructions.

INVESTIGATION FINDINGS:

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On 12/16/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to deliver investigative findings regarding the allegation listed above. LPA met with Administrator, Ricardo Gomez who was informed of the purpose of the visit.

It was alleged on 8/6/2024 Resident 1 (R1) was prescribed a medication by a physician and the facility refused to administer it due to R1’s Power of Attorney (POA) agent instructing staff to not administer the medication. LPA reviewed R1’s Physician’s Report (LIC 602A) dated 2/1/24, indicating R1 exhibits confusion and is unable to communicate their needs or manage their own medication. LPA reviewed the durable POA for healthcare signed on 8/5/2020 granting R1’s POA agent the power to make decisions relating to medical treatment including medication.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

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 18-AS-20240809151239

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: HIGHGATE SENIOR LIVING-TEMECULA	FACILITY NUMBER: 331800160
	VISIT DATE: 12/16/2024

NARRATIVE

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LPA conducted an interview with R1’s POA agent who reported they were informed by R1's family that R1 was observed more confused than usual and required medication. R1's POA agent reported R1 has a private caregiver who reported to them that R1's level of confusion was at their baseline. R1's POA agent reported they never instructed facility staff to not administer the medication and were simply waiting on additional information from medical professionals before agreeing to the medication in question due to receiving conflicting information from R1’s family and private caregiver.

Assistant Healthcare Director (AHD), Veronica Chavez was interviewed, corroborated the information provided by R1’s POA agent, and reported the facility did not have a signed doctor’s order to administer the medication on 8/6/2024. AHD reported they assessed R1 on 8/6/2024 and 8/7/2024 and R1 was not observed with any symptoms of acute distress. AHD reported the facility received the signed doctor’s order for the medication in question on 8/8/2024 and immediately began administering the medication as prescribed.

LPA reviewed R1’s hospice care plan dated 2/2/2024 and conducted an interview with R1’s case manager who corroborated the facility did not receive a signed doctor’s order to administer the medication until 8/8/2024. LPA reviewed hospice’s “Written Confirmation of Telephone Orders” dated 8/7/24 for the medication in question, which noted the physician’s signature was obtained on 8/8/2024. LPA reviewed the Physician’s Order as of 8/16/2024 where the facility documented receiving the medication on 8/8/2024. LPA reviewed R1’s medication administration record for August 2024 and the facility documented administering the medication in question from 8/8/2024 to 8/16/2024. LPA also made contact with the reporting party who reported they do not have any concerns with the care or supervision R1 receives at the facility including medication management.

This agency has investigated the complaint alleging “Staff are not administering medication(s) to resident according to physicians instructions”. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to Administrator Gomez.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

LIC9099 (FAS) - (06/04)

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