366426871-10-7-2021-18-AS-EMAN-C8ARFJ-20211030125914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366426871
Report Date: 10/07/2021
Date Signed: 10/07/2021 10:17:50 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, 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
01/14/2021 and conducted by Evaluator Natalie Gayoso

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210114112327

FACILITY NAME:	PALA CARE CENTER INC		FACILITY NUMBER:	366426871
ADMINISTRATOR:	LAYGO, ANITA		FACILITY TYPE:	735
ADDRESS:	24830 PALA LN		TELEPHONE:	(760) 247-9241
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92307
CAPACITY:	6	CENSUS: 3	DATE:	10/07/2021
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Rufina Laygo		TIME COMPLETED:	10:27 AM

ALLEGATION(S):

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Questionable Death
Staff are using the garage as a sleeping room for residents
Staff do not keep the facility clean
Staff mismanage resident medications
Staff do not ensure that residents are adequately fed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natalie Gayoso conducted an in-office meeting to deliver findings for the above allegations. LPA introduced herself and explained the purpose of today’s visit with Administrator Rufina Laygo.

The investigation consisted of interviews with pertinent parties, records review, and observations. The first allegation indicates questionable death. Interview with Administrator stated Client 1 (C1) was in quarantine during the time of their death due to having a fever and cough. C1’s doctor prescribed medication for symptoms and instructed for C1 to be COVID tested. C1 then passed away a few days later while sleeping. LPA reviewed C1’s death certificate that stated primary cause of death was cardiorespiratory arrest with a secondary cause of intractable epilepsy.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Natalie Gayoso
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

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-20210114112327

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: PALA CARE CENTER INC	FACILITY NUMBER: 366426871
	VISIT DATE: 10/07/2021

NARRATIVE

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The second allegation indicates staff are using garage as a sleeping room for residents. Interviews with staff denied garage being used as a sleeping room for residents. Staff indicated each client has their own room. Interviews with clients stated they have their own room in the facility and that none of the clients sleep in the garage. LPA observed the garage to have a pool table for clients use and an office area. The garage also contains a staff room that the clients do not have access to.

The third allegation indicates staff do not keep the facility clean. Interviews with staff indicated the facility is kept clean at all times and is cleaned and disinfected 3 times a day. Interviews with clients stated staff are continuously cleaning the facility throughout the day. LPA observed the facility to be clean and did not observe anything to be missing.

The fourth allegation indicates staff mismanage resident medications. Interviews with staff stated that medications are handled as prescribed by the clients doctor and are not mismanaged. Staff stated they have never been instructed to open medication from another home/facility and bring it to the clients in care. Interview with clients stated staff give them their medications as prescribed by their doctor. Clients have never witnessed staff bring medications from other homes nor been given medication that is not theirs. LPA observed medication and MARs and did not see any discrepancies.

The fifth allegation indicates staff do not ensure that residents are adequately fed. Administrator stated the facility buys perishable food twice a week and non-perishable weekly. Interviews with staff stated clients are adequately fed and there is always enough for clients to get a second serving if they want. Interviews with Client 2 (C2) and Client 3 (C3) stated the facility does feed them well and there is always enough for a second serving. LPA observed facility to have 2 days on perishable and 7 days of non-perishable food. LPA also observed groceries receipt that show an adequate amount of food is purchased weekly.

Based on interviews, records review, and observations, the allegations are UNSUBSTANTIATED. A finding of Unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of this report was provided to the Administrator.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Natalie Gayoso
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

LIC9099 (FAS) - (06/04)

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