336403755-7-8-2021-18-AS-EMAN-C4XQBP-20210715120149

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403755
Report Date: 06/25/2021
Date Signed: 07/08/2021 01:06:52 PM

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
03/10/2020 and conducted by Evaluator Elecia Weathersby

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200310145259

FACILITY NAME:	GOLDEN CARE SENIOR LIVING ON RAMSEY		FACILITY NUMBER:	336403755
ADMINISTRATOR:	JUANITA VELOSO		FACILITY TYPE:	740
ADDRESS:	3863 WEST RAMSEY		TELEPHONE:	(951) 849-7521
CITY:	BANNING	STATE: CA	ZIP CODE:	92220
CAPACITY:	49	CENSUS: 21	DATE:	06/25/2021
		UNANNOUNCED	TIME BEGAN:	11:00 PM
MET WITH:	Administrator, Juanita Veloso		TIME COMPLETED:	11:45 PM

ALLEGATION(S):

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(10) Neglect -
- Resident has open wound on the side of the head
- Resident has untreated pressure wound.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elecia Weathersby made an unannounced vist to the facility to deliver findings for the above allegations. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with current facility interim Administrator, Juanita Veloso.

Allegation #1: Resident has open wound on the side of the head
The investigation was conducted by the Department. The investigation consisted of records review and interviews with relevant parties. The allegation indicates that facility staff neglected resident, R1 resulting in an open wound on the left side of the face that has been untreated.

The department completed the investigation and deemed the allegation to be unfounded. R1's primary care physician (S1), stated that the worsening of R1's wound was not a result of neglect. It was cancer that made it worse. S1 stated that R1's wound is a skin cancer lesion that has been treated by the primary care physician S1, visiting nurses, caregivers, and hospice nurses since R1 arrived at the facility. S1 stated that R1's wound has been getting worse progressively since November 2019. Therefore, based on the statements from the resident, witnesses, and R1's primary doctor (S1), the allegation is unfounded. The Department has found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis.

This reports continues on LIC 9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Elecia Weathersby	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

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-20200310145259

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: GOLDEN CARE SENIOR LIVING ON RAMSEY	FACILITY NUMBER: 336403755
	VISIT DATE: 06/25/2021

NARRATIVE

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Allegation #2: Resident has untreated pressure wound
On 9/3/2020, due to the COVID-19 pandemic, LPA Weathersby conducted an unannounced phone interviews with facility Administrator, Juanita "Nita" Veloso and staff. The Administrator, Juanita "Nita" Veloso, explained that the resident in question R2, resides in the facility, and has never had an untreated pressure wound on the buttocks area.

Upon review of evidence collected, hospice documentation, facility notes, and staff interviews, the department has determined that pressure wound care treatment was being provided to the resident who is the subject of this investigation.

On 7/8/2021, LPA Weathersby made a follow-up unannounced visit to the facility and spoke to interm Administrator, Juanita Veloso, to advise that this agency has investigated the allegation of, resident has untreated pressure wound, and explained that the Department has found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis.

An exit interview was conducted with interm Administrator, Juanita Veloso and a copy of this report was provided to Ms. Veloso.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Elecia Weathersby	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC9099 (FAS) - (06/04)

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