374603513-2-29-2024-08-AS-LTEZ-D3PTZT-20240325151053

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603513
Report Date: 02/29/2024
Date Signed: 02/29/2024 11:44:34 AM

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 Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20240220090113

FACILITY NAME:	PARKWAY GARDENS RETIREMENT CARE HOME		FACILITY NUMBER:	374603513
ADMINISTRATOR:	CARMINDA RAMIREZ		FACILITY TYPE:	740
ADDRESS:	660 VAN HOUTEN AVE		TELEPHONE:	(619) 444-2729
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92020
CAPACITY:	15	CENSUS: 9	DATE:	02/29/2024
		UNANNOUNCED	TIME BEGAN:	10:06 AM
MET WITH:	Art Vinarao, Caregive		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Staff mismanaged resident's medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to open a complaint and deliver findings. LPA was allowed entry by Art Vinarao, Caregiver. LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Manager.

On February 20, 2024, a complaint was received regarding Staff mismanaged residents' medication. The purpose of this investigation was to determine the validity of the allegation and take appropriate actions if necessary.

The following were reviewed and observed as part of the investigation: Residents' records, Medication Administration Records (MAR), and a facility tour on February 29, 2024.

{Continued on 9099C}

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 08-AS-20240220090113

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: PARKWAY GARDENS RETIREMENT CARE HOME	FACILITY NUMBER: 374603513
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/29/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/29/2024 Section Cited HSC 80075(b)	1 2 3 4 5 6 7	80075(b)Clients shall be assisted as needed with….medications. (5) If the client's physician has stated in writing that the client is unable to determine his/her own….the licensee shall be permitted to assist the client... (B) Once ordered by the physician the medication is given according….This requirement was not met:	1 2 3 4 5 6 7	The correction had been made based on records reviewed, outside sources, resident statements. The PRN did not have any side affects per the SW and no immediate health risk.
	8 9 10 11 12 13 14	Based upon interviews and records reviewed. This deficiency may pose a potiential Health and Safety risks to residents in care.	8 9 10 11 12 13 14	date corrected 02/20/2024
	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: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240220090113

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: PARKWAY GARDENS RETIREMENT CARE HOME	FACILITY NUMBER: 374603513
	VISIT DATE: 02/29/2024

NARRATIVE

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Allegation: Staff mismanaged residents' medication. The investigation found that staff members did not follow prescribed medication administration per the prescription order. LPA interviewed staff, outside sources, and the resident all stated that the dosage had been given as prescribed it was only at bedtime according to the medical records in December 2023. The increase took place on January 23, 2024. However, it was noticed by the outside source that the medication was given at the prior dosage on February 2, 2024, during a visit with the resident. The staff, outside sources, and resident all stated that the medication had been given at the correct dosage as of February 20, 2024.

Based on the evidence obtained during the complaint investigation, the allegation was found to be SUBSTANTIATED, as there is a preponderance of evidence to prove the alleged violation occurred.

An exit interview was conducted with Art Vinarao, Caregiver. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Caregiver and his signature on this report confirms receipt of the Licensee Rights.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

LIC9099 (FAS) - (06/04)

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