405800577-2-8-2024-29-AS-KBUY-D2W3RH-20240228172845

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405800577
Report Date: 02/08/2024
Date Signed: 02/08/2024 05:37:07 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/25/2024 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20240125085421

FACILITY NAME:	VILLAGE AT SYDNEY CREEK, THE		FACILITY NUMBER:	405800577
ADMINISTRATOR:	KIRK P KLOTTHOR		FACILITY TYPE:	740
ADDRESS:	1234 LAUREL LANE		TELEPHONE:	(805) 543-2350
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	84	CENSUS: 60	DATE:	02/08/2024
		UNANNOUNCED	TIME BEGAN:	01:34 PM
MET WITH:	Lisa Hulse, Vice President		TIME COMPLETED:	05:50 PM

ALLEGATION(S):

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Facility is not meeting the medical needs of residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted a subsequent complaint visit to deliver final findings for the above allegation. LPA Olson interviewed Staff on 1/29/24 and 2/8/24, LPA attempted to interview Residents and requested relevant documents on 1/29/24. During today’s visit, LPA met with Vice President and explained the reason for the visit.

On the allegation: Facility is not meeting the medical needs of residents. It was alleged that a resident’s ability to use their hand declined due to a brace not worn and exercises not done, and the resident’s nails were not maintained and dug into the skin of their palm. It was also alleged that a resident has a skin condition that was not properly being addressed by the facility. LPA interviewed LVN who stated most residents see the same doctor who sends their nurse practitioner to the facility once a week. They have their own list of residents to follow up with, as well as the facility’s list of residents we would like them to look into. LVN stated that any fall, change in condition, or medication change are addressed, or if the facility is concerned in any way. Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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 29-AS-20240125085421

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VILLAGE AT SYDNEY CREEK, THE	FACILITY NUMBER: 405800577
	VISIT DATE: 02/08/2024

NARRATIVE

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LPA reviewed multiple residents files. LPA observed the facility faxed the doctor in regards to Resident 1 (R1)’s weight loss and weight gain. LPA observed the facility faxed R1’s doctor on 10/4/23 requesting home health be ordered due to a right hand contracture. The doctor asked for more information so another fax was sent 10/5/23 stating R1 has contracture to the right hand and was seen by home health, a splint was ordered and R1 was wearing it but now the hand is back to where it started 6 months ago because the brace was not being used, so the facility is requesting Physical Therapy (PT)/Occupational Therapy (OT). LPA interviewed staff about R1’s PT/OT for their hands and the brace. Interviews revealed the brace was not used and discontinued due to the resident constantly being in pain and there being a moisture problem. Staff stated there is now a softer device placed in R1's hand and staff state they constantly check it and ensure it's being used.

On 1/29/24 LPA Olson observed resident fingernails in Neighborhood 3. LPA observed multiple residents who had fingernails that appeared long, and some that were jagged and could pose a potential danger if used to scratch. LPA spoke with LVN about the policy for nail care. LVN stated the facility has a Podiatrist who sees residents monthly to care for their toenails. The LVN tries to trim residents fingernails when they do rounds and observe they need trimming, but there is no set schedule to trim the nails. LPA showed LVN pictures of 3 residents nails that needed trimming. LVN said they would go and trim those nails.

On 2/8/24 LPA observed R1's scalp to be flaky and green/yellow scabs on R1’s scalp. Records reviewed indicated the facility regularly contacted R1’s doctor regarding the skin condition, and an ointment and shampoo was prescribed by the doctor. Records and interviews indicate staff used the ointment as prescribed and R1’s condition occasionally flares up but facility is managing it as best they can with prescription shampoo and PRNs ordered by R1's doctor.

LPA attempted to interview residents about their medical care but they were unable to respond to LPA’s questions. Interviews with staff revealed residents medical needs are always reported timely to the medtech or LVN.

Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of report issued.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC9099 (FAS) - (06/04)

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