361800177-4-18-2023-18-AS-JDHS-CRGQ8H-20230503115645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800177
Report Date: 04/18/2023
Date Signed: 04/18/2023 10:15:50 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,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/16/2021 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210316173114

FACILITY NAME:	PARADISE FOR THE ELDERLY #2		FACILITY NUMBER:	361800177
ADMINISTRATOR:	MADAHAR, RENU		FACILITY TYPE:	740
ADDRESS:	8568 BAKER AVE		TELEPHONE:	(909) 463-8432
CITY:	RANCHO CUCAMONGA	STATE: CA	ZIP CODE:	91730
CAPACITY:	6	CENSUS: 6	DATE:	04/18/2023
		UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	Renu Madahar, Administrator		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Staff neglect resulting in resident developing pressure injuries.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs), Stephanie Torres and Cheryl Goodrich, conducted an unannounced visit to the facility to deliver the findings of the investigation into the above allegation. The LPA met with Administrator, Renu Madahar, and informed her of the purpose of the visit.

An allegation was received by the Department alleging Resident One (R1) developed multiple wounds on their body due to lack of care. The investigation included a review of facility resident records, hospice and home health records and interviews with pertinent witnesses. R1 was admitted to the facility on February 11, 2021 and began receiving hospice services on February 12, 2021. According to information received, R1's responsible party discontinued hospice services on or around February 18, 2021. Interviews and records show R1 began receiving Home Health services from February 23, 2021 through March 12, 2021. A comprehensive Nursing Assessment shows an assessment of the resident was conducted on February 23, 2021, and notes R1 was diagnosed with a pressure ulcer of sacral region, Stage 4; and a stage 2 to the sacral region. Additional home health notes show R1 was observed to have a pressure ulcer stage 2 noted on the coccyx on or around

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

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-20210316173114

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: PARADISE FOR THE ELDERLY #2	FACILITY NUMBER: 361800177
	VISIT DATE: 04/18/2023

NARRATIVE

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February 25, 2021, with additional wounds (staging not noted) were observed on or around March 07, 2021. On or around March 1, 2021 one wound was reported to have progressed to a stage 4 on a Physician's Orders report.

The resident was later hospitalized on March 12, 2021; records show R1 was observed to have multiple injuries; including a pressure ulcer of sacral region, stage 4.

Facility staff were interviewed and reported wounds were not observed on R1, however staff reported R1 was rotated every two hours. The Administrator stated R1 needed “aggressive wound care” but that home health was unwilling to come in regularly. Administrator stated home health told them “not to touch the wound.”

Based on the investigation, the allegation that staff neglect resulted in resident developing pressure injuries could not be corroborated. Therefore, this allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation occurred.

This report was reviewed with Madahar and a copy was provided.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

LIC9099 (FAS) - (06/04)

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