374602369-2-26-2024-08-AS-JLOT-D2X23G-20240229160220

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602369
Report Date: 02/26/2024
Date Signed: 02/26/2024 05:20:23 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/20/2024 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20240220113601

FACILITY NAME:	GOLDEN LIVING HEALTH MANAGEMENT, INC.		FACILITY NUMBER:	374602369
ADMINISTRATOR:	ROCIO GRANDA		FACILITY TYPE:	740
ADDRESS:	3223 DUKE STREET		TELEPHONE:	(619) 222-1109
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92110
CAPACITY:	113	CENSUS: 91	DATE:	02/26/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator, Rocio Granda		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Facility staff did not administer medications as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to commence a complaint investigation and delivered findings. LPA identified herself and discussed the allegation mentioned above with Administrator, Rocio Granda.

On February 20, 2024, Community Care Licensing (CCL) received a complaint alleging that facility staff did not administer medications to R1 as prescribed, [an LIC 811 Confidential Names List was provided to staff to identify the resident]. It was specifically alleged that staff did not administer the Nortriptyline, 50 ml according to the physician's orders. Per the physician's orders, R1 was to be administered one capsule for anxiety and depression daily before bedtime. A review of the physician's notes indicated that on February 18, 2024, when R1 was admitted to the hospital, (due to an unrelated condition), R1 had not been administered the medication. A review of the physician's notes indicated that the facility had run out of the Nortriptyline, and it was uncertain as to how long R1 had not been given the medication.
(Continue at LIC9099C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

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 08-AS-20240220113601

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GOLDEN LIVING HEALTH MANAGEMENT, INC.	FACILITY NUMBER: 374602369
	VISIT DATE: 02/26/2024

NARRATIVE

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(Continue from LIC9099)

According to the physician’s notes, on February 18, 2024, R1’s medical condition had been negatively affected due to the lack of medication. On February 26, 2024, during a visit to the facility, a review of R1’s medication administration records (MARs) confirmed that R1 had not been administered the medication as prescribed for nine (9) days from February 10th to February 18th, 2024. In addition, the MARs review disclosed that there was another medication that was not administered as prescribed from January 29, 2024, to February 18, 2024. According to the MAR’s notes, staff ordered a refill of the Nortriptyline on February 14, 2024. In addition, per the MARs review, there was no record if the medication refill was placed for the 2nd medication not administered. During interviews, staff indicated they did not know why the medication refills were not placed on a timely manner to meet R1’s needs. According to R1’s physician’s report, R1 needs assistance with medication management. No other explanation of why additional follow-up was not performed by staff to ensure medication refills for R1 were processed on time was obtained during the investigation.

The Department has investigated the above-mentioned allegation and based on interviews with staff, outside sources, and records review, this allegation is deemed to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. A deficiency was cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on LIC 9099-D. A plan of correction was developed with Administrator, Rocio Granda.

An exit interview was conducted with Administrator, Granda, to whom a copy of this report, LIC 9099D Deficiency form, the Licensee Appeal Rights (LIC9058 01/16), and the LIC 811 confidential name list were provided at the conclusion of the visit.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240220113601

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GOLDEN LIVING HEALTH MANAGEMENT, INC.	FACILITY NUMBER: 374602369
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/26/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/26/2024 Section Cited CCR 87465(C)(2)	1 2 3 4 5 6 7	87465 (C)(2) Incidental Medical and Dental Care … Once ordered by the physician the medication is given according to the physician's directions… this requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to conduct additional staff training on medication management by a 3rd party provider and submit documentation of training conducted by POC deadline, 3-26-2024.
	8 9 10 11 12 13 14	Based on interviews and record review, facility staff did not administer R1 their medications as prescribed. This posed a potential health risk to 1 of 89 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.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC9099 (FAS) - (06/04)

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