336409176-3-25-2022-18-AS-EMAN-CCXP4D-20220328105857

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336409176
Report Date: 12/23/2021
Date Signed: 03/25/2022 01:53:58 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
10/07/2021 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211007102415

FACILITY NAME:	LAKES, THE		FACILITY NUMBER:	336409176
ADMINISTRATOR:	TERRY RECORDS		FACILITY TYPE:	740
ADDRESS:	5801 SUN LAKES BLVD		TELEPHONE:	(951) 845-2220
CITY:	BANNING	STATE: CA	ZIP CODE:	92220
CAPACITY:	237	CENSUS: 92	DATE:	12/23/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Amanda McElwain		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff mismanages residents' medication.
Residents do not receive medication as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Melody Brown and Bernadette Allen made an unannounced visit to commence a complaint investigation as well as to deliver findings for the allegation(s) listed above.LPAs met with Business Office Director (BOD) Karla Espinoza and explained the purpose of the visit. BOD Espinoza contacted Memory Care Director Amanda McElwain to assist LPAs Brown and Allen on the complaint investigation. The investigation consisted of review of medicine records, file review, interviews with staff and residents as well as observation.

The first allegation indicates staff mismanages resident’s medication. LPA Brown reviewed medication records, as well as the prescribed medications,which revealed that Resident # 9 (R9) and Resident # 8 (R8) was given twice the dose instead of a single dose of prescribed medication. LPA attempted to interview R9 and R8 but both were not able to confirm that they had been over-medicated.
***Continuation in LIC9099C***

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

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-20211007102415

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: LAKES, THE	FACILITY NUMBER: 336409176
	VISIT DATE: 12/23/2021

NARRATIVE

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However, it was confirmed during the staff interviews that R9 received twice the dose of metformin instead of a single dose and R8 received twice the dose of cream instead of a single dose.

The second allegation indicates Residents do not receive medication as prescribed. LPA Brown reviewed medication records, as well as the prescribed medications, which revealed that Resident # 2 (R2) was in fact not given their medications prescribed for the day. LPA Brown attempted to interview R2 who was not able to confirm that they had been without their medications. However, it was confirmed during staff interviews that R2 was missing a day of medications. During the visit, Staff 2 (S2) reported that Staff 4 (S4) was removed from medication cart duty and S4 will be retrained on medication distribution. In addition, during the visit, Staff 9 (S9) reported that S4 was terminated 12/01/2021.

Therefore, the allegation of Staff mismanages resident’s medication (Allegation # 1) and Residents do not receive medication as prescribed (Allegation # 2) are SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Based on the observations made during today’s visit, deficiency will be cited per Title 22 Division 6 of the California Code of Regulations. Refer to LIC809D for deficiency cited.

An exit interview was conducted where this report (LIC9099), LIC9099D, and Appeal Rights were discussed and provided to Memory Care Director Amanda McElwain.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20211007102415

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: LAKES, THE	FACILITY NUMBER: 336409176
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/23/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/27/2021 Section Cited CCR 87465(c)(2)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care:(c) If the resident's physician has stated in writing ...(2) Once ordered by the physician the medication is given according to the physician's directions.	1 2 3 4 5 6 7	Licensee stated that they will retrain all med tech staff on medication distribution. Copy of staff training to be submitted to LPA Brown by POC date.
	8 9 10 11 12 13 14	This requirement was not met as evidence by: interviews with staff revealed thatresident # 8 (R8) and resident # 9 (R9) were not given their medications as prescribed. This poses an immediate risk to the resident in care	8 9 10 11 12 13 14
Type A 12/27/2021 Section Cited CCR 87465(c)(2)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care:(c) If the resident's physician has stated in writing ...(2) Once ordered by the physician the medication is given according to the physician's directions.	1 2 3 4 5 6 7	Licensee stated to complete an in-service training with all Medtech staffs on appropriate medications training to ensure that residents were given their prescribed medications. Copy of staff training to be submitted to LPA Brown by POC date.
	8 9 10 11 12 13 14	This requirement was not met as evidence by: interviews with staff revealed that last 09/22/2021, resident #2 (R2) was not given their medications prescribed. This poses an immediate risk to the resident in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

LIC9099 (FAS) - (06/04)

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