374603713-3-20-2023-08-AS-SJAB-CQEUBN-20230330152638

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603713
Report Date: 03/20/2023
Date Signed: 03/20/2023 10:17:48 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, 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
11/15/2022 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20221115153141

FACILITY NAME:	PARKVIEW MEMORY CARE AT PARADISE VILLAGE		FACILITY NUMBER:	374603713
ADMINISTRATOR:	AGUILAR, GEOVANNI		FACILITY TYPE:	740
ADDRESS:	735 ARCADIA AVENUE		TELEPHONE:	(619) 475-5040
CITY:	NATIONAL CITY	STATE: CA	ZIP CODE:	91950
CAPACITY:	70	CENSUS: 46	DATE:	03/20/2023
		UNANNOUNCED	TIME BEGAN:	03:50 PM
MET WITH:	Patricia Pestano Resident Care Coordinator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Resident developed multiple pressure injuries while in care.

Facility staff mismanaged resident's medications.

Facility staff did not inform responsible party of resident's change of condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings to the above mentioned complaint allegations. LPA identified herself and discussed the purpose of the visit with Resident Care Coordinator Patricia Pestano.

The Department’s investigation consisted of facility and outside records review, interviews with staff, residents and outside sources.

It was alleged that neglect/lack of care and supervision of a resident resulted in multiple pressure injuries. Review of resident records revealed that on 08/03/22 Resident #1 (R1), (See LIC811 Confidential Names list), Physician’s Report did not indicate any skin issues.

Continue on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

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 08-AS-20221115153141

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: PARKVIEW MEMORY CARE AT PARADISE VILLAGE	FACILITY NUMBER: 374603713
	VISIT DATE: 03/20/2023

NARRATIVE

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Facility record dated 10/14/22 indicated R1’s skin was not intact, Staff #1 (S1) documented a lump on R1’s right buttock. Based on records review, S1 did not inform the Staff #2 (S2) or Staff #3 (S3) that R1 had a lump on their right buttock.

Facility records indicated that on 10/17/22 S1 notified outside source #1 (OS1) of an open area on R1’s right buttock. On 10/19/22, S3 documented that R1 had an open wound on their right buttocks. S3 then notified OS1 and informed them that R1’s Primary Care Physician would be notified of the change in condition. LPA confirmed that on 10/22/22, R1’s Primary Care Physician was informed. On 10/22/22, S3 documented that R1 was bleeding from the right buttock. On 10/23/22, OS1 requested that the facility contact emergency services and R1 was sent to the hospital for further evaluation at 3:45 pm. On the same day at approximately 8:35 pm, R1 returned to the facility with a diagnosis of Skin Maceration, Cellulitis, and Unspecified Cellulitis site. R1 was prescribed antibiotics and the hospital requested the facility to reposition R1 every 2 hours to keep the skin condition from becoming worse.

It was alleged that the facility mismanaged R1’s medications. During the discharge process, OS1 stated that when the discharge medications were given to OS1, there was one bottle that did not belong to R1. The medication bottle was sealed and there was no evidence that R1 was given the medication. It was alleged that OS1 gave the staff member the medication that did not belong to R1. There was no documentation of the said incident in any review of records or interviews with staff. OS1 could not recall the name of the medication or the staff member they gave it to.

It was alleged that the facility did not inform responsible party of resident’s change of condition. Based on records reviewed and interviews, R1’s change of condition was documented by staff and OS1 was being updated of R1’s change of condition as it occurred on 10/14/22, 10/17/22, 10/19/22, 10/22/22 and 10/23/22.

Based on records review, staff interviews and outside sources interviewed, there is not a preponderance of evidence of resident developing multiple pressure injuries while in care, resident’s medication being mismanaged and the facility did not inform responsible party of resident’s change of condition Therefore, the allegations are unsubstantiated.

An exit interview was conducted with the Administrator A copy of this report, and Licensee Appeal Rights (9058 03/22) were provided to the Resident Care Coordinator whose signature on this form confirms receipt of these documents.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

LIC9099 (FAS) - (06/04)

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