405802284-12-22-2022-29-AS-KBUY-CMLNCP-20221230092104

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405802284
Report Date: 12/22/2022
Date Signed: 12/22/2022 02:43:17 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
12/19/2022 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20221219160755

FACILITY NAME:	ROSES ASSISTED LIVING LLC		FACILITY NUMBER:	405802284
ADMINISTRATOR:	VICTORIA THORNE		FACILITY TYPE:	740
ADDRESS:	7270 VALLE AVE		TELEPHONE:	(805) 462-3302
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	6	CENSUS: 5	DATE:	12/22/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Bernadette Torres-Hust, Caregiver		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff did not ensure medications were locked.

INVESTIGATION FINDINGS:

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On 12/22/22 at 12:30 pm, Licensing Program Analyst (LPA) Chavez conducted an unannounced 10-day complaint investigation visit to the facility listed above. LPA met with Bernadette Torres-Hust, Caregiver and explained the purpose of the visit. At 12:38 pm, LPA spoke by phone with administrator Victoria Thorne and explained the reason for the visit. Administrator gave authorization for Ms. Torres-Hust to sign the report in the administrator’s absence.
On the allegation, “Facility staff did not ensure medications were locked,” the complainant was concerned that pills were found in the facility and that medication technicians (med-techs) were not ensuring residents received their medications. To investigate, LPA toured the facility, made observations, interviewed the administrator and staff, and reviewed records.

Continued on 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

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 29-AS-20221219160755

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: ROSES ASSISTED LIVING LLC	FACILITY NUMBER: 405802284
	VISIT DATE: 12/22/2022

NARRATIVE

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Between 12:38 pm and 1:53 pm, LPA spoke with the administrator. Administrator states that on rare occasions staff have brought pills they found to her and she destroys them. She says recently staff found two pills in the living room and placed these in her office. She says she immediately destroyed the pills. She states she was unable to identify the pills as the markings were dissolved. Administrator states that they have one resident who occasionally hides pills in “pockets” of their mouth, and she has instructed staff to look closer in resident’s mouth to ensure this doesn’t happen.

Between 12:55 pm and 2:00 pm, LPA interviewed staff. Staff say when they dispense medications to residents, they watch residents to make sure they take all their medications and ask residents to open their mouths so they can see that they’ve taken them. Staff showed LPA where medications are stored. LPA observed resident medications in a cabinet in the locked office in the garage. LPA observed staff opening the office with a code on the keypad. Staff say the office door is always locked. Staff state that they only retrieve medications from the office at the time residents need to take them.

LPA reviewed medication administrator records (MARS) for all five residents. Administrator and staff interviews reveal that topical medications are being recorded when given and all other medications are being recorded when prepared. LPA advised the administrator to follow the instructions on the MARS which state, “Put initials in appropriate box when medication is given”, not when prepared.

Based on evidence obtained, the allegation “Facility staff did not ensure medications were locked,” is Unsubstantiated at this time. There is no evidence indicating medications are being stored improperly or mismanaged.

Exit interview conducted and report emailed to the administrator.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

LIC9099 (FAS) - (06/04)

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