331800160-4-21-2022-18-AS-KCLS-CEQKWK-20220524081601

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800160
Report Date: 04/21/2022
Date Signed: 04/21/2022 02:24:06 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/21/2021 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210521131730

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: 91	DATE:	04/21/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Kathleen Williams		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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#1 Resident developed a pressure injury while in care
#2 Resident sustained multiple falls while in care
#3 Facility staff did not follow doctors orders
#4 Facility staff did not have resident re-appraised
#5 Facility staff did not ensure that resident had clothing that fit correctly
#6 Facility staff did not assist resident with hygiene needs
#7 Facility staff did not seek medical attention in a timely manner
#7 Facility staff did not safeguard resident's personal property

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to deliver findings regarding a complaint investigation. LPA met with Executive Director Kathleen Williams. The following allegations were addressed. Allegation #1 - Resident documentation was obtained to reveal that resident #1 (R1) has documentation of all care received at the facility and visits to a medical facility to address care to R1. LPA obtained documentation doctor's orders were followed or no new orders were given for continuing care by the facility. Each visit was documented and facility followed the medical professionals directives. Allegation #2 - R1 was initially assessed being as independent, with no assistance needed for mobility and later assessed as a fall risk. Documentation reveals fall risk procedures were followed. Falls were documented by facility and that documentation was obtained by LPA. Allegation #3 - LPA obtained documentation that doctor's orders were followed after every visit to a medical professional facility. Medical summaries were also obtained when no new orders were given.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: 9512480349(323) 981-3968
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

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-20210521131730

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: HIGHGATE SENIOR LIVING-TEMECULA	FACILITY NUMBER: 331800160
	VISIT DATE: 04/21/2022

NARRATIVE

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Allegation #4 - LPA obtained facility documentation that reveals R1 was initially assessed and continued to be re-assessed throughout R1's stay at the facility. Allegation #5 - Resident was no longer residing at the facility to observe if clothes fit or did not fit properly. Staff #1, (S1) interviewed states R1's clothes fit properly and states R1 was cleaned and well kept. Allegation #6- Documentation reveals that R1 was on a service plan that addresses hygiene needs. Assessments made by facility notes changes and updates as needed. Allegation #7 - Documentation obtained reveals R1 doctors reports and summaries for each visit to a medical facility that were addressed in a timely manner. Allegation #8 - Interviews and documentation that reveal R1 personal property was safeguarded as the facility was providing supplies and other items for R1.

Based on the information obtained there is not enough evidence that resident developed a pressure injury while in care, resident sustained multiple falls while in care, facility staff did not follow doctors orders, facility staff did not have resident re-appraised, facility staff did not ensure that resident had clothing that fit correctly,
facility staff did not assist resident with hygiene needs, facility staff did not seek medical attention in a timely manner, facility staff did not safeguard resident's personal property. Therefore, the allegations were deemed UNSUBSTANTIATED at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: 9512480349(323) 981-3968
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

LIC9099 (FAS) - (06/04)

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