331880802-5-30-2023-18-AS-JESL-CSD76V-20230531212346

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880802
Report Date: 05/30/2023
Date Signed: 05/30/2023 11:25:49 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, 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
04/08/2022 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220408103115

FACILITY NAME:	MURRIETA GARDENS		FACILITY NUMBER:	331880802
ADMINISTRATOR:	NIARE FEASTER		FACILITY TYPE:	740
ADDRESS:	24200 MONROE AVE		TELEPHONE:	(951) 600-7676
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92562
CAPACITY:	72	CENSUS: 50	DATE:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Brittany Kavaungh, Executive Director		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Resident sustained unexplained injury while in care.
Staff did not address a resident's change in medical condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George arrived unannounced at the facility to investigate and deliver findings for the allegation listed above. LPA met with Executive Director Brittany Kavanaugh and explained the purpose of the visit and elements of the allegation(s) listed above.

The investigation consisted of observation, interviews and a review of documentation. Regarding resident sustained unexplained injury while in care. Resident #1 (R1) was a respite and stayed at the facility for a total of 6 days (3/31/22-4/5/22). R1 is noted to be bed bound, unable to walk and can feed themself finger foods. Per R1s Physician’s report to require 2-person assistance with transferring and toileting. On 4/5/22 R1 was observed to have a bump on the right side of their forehead. There is no documentation from the facility discussing a fall or even facility staff observing that R1 in fact had the bump prior to 4/5/22. Per the facility’s progress notes for R1 there are not consistent entries, however on the days that had entries (4/3/22 and 4/4/22), there is no discussion of a bump being observed anywhere on R1s body. R1 was noted to have eaten all meals in the dining room and that they had participated in activities.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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 18-AS-20220408103115

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: MURRIETA GARDENS	FACILITY NUMBER: 331880802
	VISIT DATE: 05/30/2023

NARRATIVE

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R1 was unable to state what happened as R1 is nonverbal. Based on observation, interviews and record review the allegation of Resident sustained unexplained injury while in care is UNSUBSTANTIATED.

Allegation: Staff did not address resident's change in medical condition
Licensing Program Analyst (LPA) Javina George arrived unannounced at the facility to investigate and deliver findings for the allegation listed above. LPA met with Executive Director Niare Feaster and explained the purpose of the visit and elements of the allegation(s) listed above.

The investigation consisted of observation, interviews and a review of documentation. Regarding resident sustained unexplained injury while in care. Resident #1 (R1) was a respite and stayed at the facility for a total of 6 days (3/31/22-4/5/22). It is noted in R1s physician’s report dated 3/24/22, to have a history of skin breakdown and redness to R1s coccyx, and that barrier cream is to be used at each diaper change. A review of R1s hospice plan of care dated 3/30/22. It notes an unresolved goal that was created 8/23/21 for targeting integumentary/skin noting to have the skin to perineal area/buttocks/coccyx heal, as the area is noted to be tender due to excoriation (skin picking), and red areas. R1 began their respite stay on 3/31/22, R1s skin was noted to already have irritation. Additionally, there were preventative measures in place as barrier cream had to be applied with each diaper change, and to have timely incontinence care, per R1s hospice care plan. Therefore, the allegation of staff did not address resident's change in medical condition is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that 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.

An exit interview was conducted, and a copy of this report was provided to Brittany Kavanaugh, Executive Director.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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