374604043-8-19-2022-18-AS-DMUN-CHRU27-20220829151127

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604043
Report Date: 08/19/2022
Date Signed: 08/19/2022 12:50:19 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, 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
05/12/2022 and conducted by Evaluator Tricia Danielson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220512125037

FACILITY NAME:	OAK HILL RESIDENTIAL CARE IV		FACILITY NUMBER:	374604043
ADMINISTRATOR:	LOFVENDAHL, BRIGITTA M		FACILITY TYPE:	740
ADDRESS:	642 TRANQUILITY GLEN		TELEPHONE:	(760) 743-8843
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92027
CAPACITY:	15	CENSUS: 14	DATE:	08/19/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	MayAnn Valledor, LVN Bree Lofvendahl, Executive Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident was physically assaulted while in care
Resident sustained injuries while in care
Facility staff failed to properly observe resident for bruises

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conclude a complaint investigation into the allegations noted above. LPA met with LVN MayAnn Valledor. Executive Director Bree Lofvendahl joined via telephone and explained the purpose of the visit.
Regarding the allegations “Resident was physically assaulted while in care” and “Resident sustained injuries while in care”, it was alleged that Resident #1(R1) was physically assaulted by an unknown person at the facility during the night on May 10, 2022 resulting in a fractured arm. It was also alleged that R1 was struck on the head resulting in a headache during the same assault. The investigation revealed conflicting statements made by R1 concerning who committed and when the alleged assault took place. R1 ultimately accused a facility caregiver who was not on the schedule at the time of the alleged assault. Facility staff documentation concerning R1 made on the morning following the alleged assault indicated R1 was found with their right upper arm caught in the bed rail. R1 was repositioned without verbalizing any complaints. Records indicated, R1 was found fifteen minutes later laying diagonally across their bed and against the bed rail once again and one half hour after that, staff observed bruising to the arm and shoulder area. (CONTINUED ON LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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-20220512125037

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: OAK HILL RESIDENTIAL CARE IV	FACILITY NUMBER: 374604043
	VISIT DATE: 08/19/2022

NARRATIVE

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(CONTINUED FROM LIC9099)
It was then that R1 began to complain of pain. Furthermore, interviews conducted with a medical professional revealed R1’s fracture was not usually caused by being struck as R1 has alleged. Regarding the allegation “Facility staff failed to properly observe resident for bruises”, it was alleged that R1 was found to have bruising near to the buttocks area which facility should have been aware of. The investigation revealed facility staff documentation indicated no observed bruising to R1’s buttock area during dressing and grooming on the day in question. The investigation also indicated facility staff regularly and thoroughly document R1’s condition and behaviors.
The above allegations are found to be UNSUBSTANTIATED. 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, therefore the allegations are unsubstantiated at this time.
An exit interview was conducted and a copy of this report along with LIC 811- Confidential Names list was provided.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

LIC9099 (FAS) - (06/04)

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