331880909-11-8-2021-18-AS-NBRN-C8PS3A-20211112123048

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880909
Report Date: 11/08/2021
Date Signed: 11/08/2021 09:50:29 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
05/25/2021 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210525165123

FACILITY NAME:	VELASCO HOME		FACILITY NUMBER:	331880909
ADMINISTRATOR:	SAENZ, ISAIAH		FACILITY TYPE:	735
ADDRESS:	51320 AVENIDA VELASCO		TELEPHONE:	(760) 972-4355
CITY:	LA QUINTA	STATE: CA	ZIP CODE:	92253
CAPACITY:	4	CENSUS: 4	DATE:	11/08/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Nicole Lara		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff mismanaged client's medication

INVESTIGATION FINDINGS:

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On 11/8/21 Licensing Program Analyst (LPA) Shaunte Henry conducted an unannounced visit for the purpose of delivering the findings to the above allegations. The LPA met with Nicole Lara explained the nature of the visit and was granted entry.

The investigation, which consisted on interviews and file review revealed the following:
The above allegation suggests that the facility mismanaged Client 1(C1)'s medication. During an interview with the licensee, he stated that when a client is admitted to the hospital, the receiving party is provided with a copy of the client's medication administration record (MAR) so that the medication can be provided to the client while admitted. If the hospital does not have the medication readily available, the hospital will contact the client's home facility to request that the medication is brought to the hospital.
***Continued on 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Shaunte Henry
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021

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-20210525165123

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: VELASCO HOME	FACILITY NUMBER: 331880909
	VISIT DATE: 11/08/2021

NARRATIVE

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***Continued from 9099***

On 5/21/21, C1 was admitted to the hospital and a copy of their MAR was provided to emergency medical services (EMS). On 5/24/21, the facility received a call from the hospital stating that they did not have standing orders for C1. C1 was not provided his medication from 5/21/21 to 5/24/21 while they were admitted to the hospital. C1 was discharged back to their home facility on 5/24/21. A review of C1's MAR indicates they were provided with medication as ordered by their physician prior to C1 being admitted to the hospital on 5/21/21.

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 at this time.

An exit interview was conducted where this report and LIC 811 were provided to John Edgington via email.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Shaunte Henry
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021

LIC9099 (FAS) - (06/04)

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