374603625-1-1-2022-08-AS-IESA-CB86BT-20220131194029

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603625
Report Date: 12/29/2021
Date Signed: 01/01/2022 12:54:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/23/2020 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20201023121626

FACILITY NAME:	STELLAR CARE		FACILITY NUMBER:	374603625
ADMINISTRATOR:	LINDA CHO		FACILITY TYPE:	740
ADDRESS:	4518 54TH STREET		TELEPHONE:	(619) 287-2920
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	120	CENSUS: 82	DATE:	12/29/2021
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Licensee, Linda Cho		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Resident sustained a fracture while in care due to lack of supervision.
Facility to not seek medical care for Resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above listed complaint allegations. LPA Correia identified herself at the facility lobby and met with Licensee Linda Cho to whom was explained the purpose for the visit.

The Department’s investigation consisted of staff, and outside source interviews, and facility and resident record reviews.

It was alleged that Resident1 (R1) sustained a fracture from an alleged fall due to neglect of care and/or supervision. R1 was 84 years old and had lived at the facility approximately two years. A record review revealed R1 had multiple health conditions and physical disabilities, including, but not limited to, Dementia, paralysis to the right side of their body, a health condition that causes difficulty to produce language either spoken, manual or written, and was wheelchair bound. Interviews revealed on August 26, 2020 R1 complained of pain to their arm to facility Staff1 (S1). S1 conducted a body check and observed bruising to R1’s arm/shoulder and contacted R1’s Medical Agency1 (A1) that had been responsible for all of R1’s medical care since 2010. On September 11, 2020 an A1 representative, referenced as an outside source (OS1), also observed bruising to R1’s right arm/shoulder.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021

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 08-AS-20201023121626

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: STELLAR CARE	FACILITY NUMBER: 374603625
	VISIT DATE: 12/29/2021

NARRATIVE

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Interviews revealed OS1 asked R1 what happened that caused the bruising and R1 replied that the bruising was the result of a fall. R1 stated “I fell back” but was unable to provide any more information due to their limited ability to communicate. A record review revealed on September 14, 2021 R1 was taken to A1's clinic for a routine visit. The medical update from the visit notates mild bruising possibly due to blood thinner.

Interviews with facility staff and a record review revealed no knowledge or any documentation of R1 sustaining a fall, or ever being found on the floor in need of help. An interview with facility Staff2 (S2) revealed R1 was a 2 person assist. S2 assisted R1 with transfers in and out of their bed. S2 stated R1 would not have been able to get themselves back up after a fall due to their paralysis. An interview with the Primary Care Physician (PCP), that had treated R1 since 2013, revealed if R1 had a fall from a wheelchair they would be unable to extend their right arm to block the fall due to paralysis of the right side of R1’s body. An interview with the Licensee revealed during this time, R1 spent most of their time in bed and had facility staff repositioning R1 every 1-2 hours, if facility staff had known about a fall, they would have sent R1 to the hospital for an examination. R1's care plan did not include a fall risk plan because R1 did not have a history of falls.

It was also alleged that facility staff did not seek medical care for R1. On August 26, 2020, R1 complained of arm/shoulder pain to facility Staff1 (S1) who then observed bruising to R1's shoulder/arm area. An interview with S1 revealed on that same day S1 reported the incident to the Medical Agency1 (A1) that had been responsible for all R1's medical care since 2010. A record review revealed R1 was taken to a routine visit to A1 and A1 staff advised S1 that the bruise/pain was due to a blood thinner medication R1 was taking and to provide pain medication to help provide relief. A record review revealed on September 17, 2020 A1 staff came to the facility to observe R1 and ordered Physical Therapy (PT) and pain medication. The following day, September 18, 2020, A1’s mobile X-Ray unit came to the facility and took an X-Ray of R1’s arm, and on September 21, 2020 A1 notified the facility that R1 had an acute humerus fracture to their right arm and would require wearing a sling. The investigation revealed no evidence to determine the cause of the fracture.

Due to lack of corroborating evidence, the finding regarding the above allegations were established to be unsubstantiated. This finding means although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted with Licensee Cho and a copy of this report along with Licensee Rights (LIC 9058 01/16) was provided to Licensee Cho via email. An electronic email read receipt confirms the documents were received.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021

LIC9099 (FAS) - (06/04)

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