366403784-8-4-2023-18-AS-JESL-CV7QJE-20230830121238

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366403784
Report Date: 08/04/2023
Date Signed: 08/04/2023 12:36:46 PM

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
08/14/2020 and conducted by Evaluator Janira Arreola

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200814105815

FACILITY NAME:	UNIVERSITY LIGHTHOUSE		FACILITY NUMBER:	366403784
ADMINISTRATOR:	DAVID NEAL		FACILITY TYPE:	735
ADDRESS:	307 EAST "C" STREET		TELEPHONE:	(909) 824-3255
CITY:	COLTON	STATE: CA	ZIP CODE:	92324
CAPACITY:	4	CENSUS: 4	DATE:	08/04/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Administrator, Vicki Estelle		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff are not meeting resident's dietary needs.
Staff over medicated resident in care resulting in hospitalization.
Staff are not ensuring resident's needs are met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate and deliver findings on the above allegations. LPA met with Administrator, Vicki Estelle who was informed of the purpose of the visit. The department conducted interviews, documented observations, and conducted records reviews.

Regarding “Staff are not meeting resident's dietary needs.”, it was alleged that R1 was on a strict low sodium diet and were fed hamburger and spaghetti (3) days in a row. The department interviewed staff who stated that none of the resident had a special diet and were fed “American” and “Mexican” food. LPA requested the plan of care for the resident during this time and found that the plan of care created 8/6/2020 stated the resident did have a low sodium diet. LPA interviewed administror who stated they did not consider the resident's diet as all meals are cooked as low sodium. LPA reviewed the facility's menu and found that it met the departments regulations. LPA did not find any meals repeated for (3) days in a row. Therefore, the allegation is unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

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-20200814105815

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: UNIVERSITY LIGHTHOUSE	FACILITY NUMBER: 366403784
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/04/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 08/11/2023 Section Cited CCR 80076(a)(6)	1 2 3 4 5 6 7	(a) In facilities providing meals to clients…( 6) Modified diets prescribed by a client's physician as a medical necessity shall be provided. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The licensee agreed to...
	8 9 10 11 12 13 14	Based on interview and records review, R1 did not receive their doctor ordered diet. This poses a potential health, saftey or personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20200814105815

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: UNIVERSITY LIGHTHOUSE	FACILITY NUMBER: 366403784
	VISIT DATE: 08/04/2023

NARRATIVE

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Regarding, “Staff over medicated resident in care resulting in hospitalization.” It was alleged that the resident was transferred to the hospital and was diagnosed with being over medicated on Medication #1 (M1). A records review was conducted by the department where it was found that Resident #1 (R1) had been prescribed M1 (3) tablets at night. LPA reviewed the MARS log for R1 and found that the medication had been accounted for. LPA reviewed the hospital discharge paperwork where it was found that on 8/20/2020 the resident was admitted for altered mental state and diagnosis of intoxication due to M1. LPA interviewed the administrator who stated they were unaware of how the resident had overdosed on M1. It was unable to be corroborated if the staff had administer a higher dose to R1. Therefore the allegation that R1 had been given too much medication by staff was found to be unsubstantiated.

Regarding, “Staff are not ensuring resident's needs are met.”, it was alleged that the facility staff refused to assist R1 with their blood pressure cuff, and had not dialed 911 when the resident requested staff to do so. LPA spoke with administrator who stated they could not recall calling 911 on the day of the incident but stated they do not refuse medical attention to their residents. Therefore, the allegation is unsubstantiated.

Findings that are unsubstantiated mean that although the allegation may be valid, the preponderance of the evidence standard has not been met. An exit interview was conducted with Administrator, Vicki Estelle where this report was reviewed and provided to them.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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