405802306-10-27-2022-29-AS-KBUY-CKQSZA-20221031141851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405802306
Report Date: 10/27/2022
Date Signed: 10/27/2022 04:55:49 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
12/22/2021 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20211222092253

FACILITY NAME:	VISTA ROSA ELDER CARE		FACILITY NUMBER:	405802306
ADMINISTRATOR:	BAILEY, JESSICA		FACILITY TYPE:	740
ADDRESS:	467 HILL STREET		TELEPHONE:	(805) 586-2200
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	25	CENSUS: 18	DATE:	10/27/2022
		UNANNOUNCED	TIME BEGAN:	02:08 PM
MET WITH:	Jessica Bailey, Administrator		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

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Facility is not providing appropriate assistance for resident’s multiple falls.
Facility did not observe changes in resident's physical health.
Staff are not assisting resident with using hearing aids.

INVESTIGATION FINDINGS:

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On 10/27/22 at 2:08 pm, Licensing Program Analyst (LPA) Chavez conducted an unannounced follow-up complaint investigation visit to the facility above to deliver final findings. LPA met with Jessica Bailey, Administrator, and explained the purpose of the visit.

On the allegation, “Facility is not providing appropriate assistance for resident’s multiple falls,” the complainant was concerned that Resident #1 (R1) had fallen three times because R1 is reluctant to use their walker. The complainant states that the facility suggested putting a floor mat or increasing bed railing and states the facility has made some effort to accommodate R1’s sleeping pattern. LPA investigated by interviewing administrator, staff, resident, and witness, and reviewing records.

On 12/29/21 at 12:47 pm, LPA interviewed R1. R1 says they don’t remember the last time they fell.

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: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 29-AS-20211222092253

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: VISTA ROSA ELDER CARE	FACILITY NUMBER: 405802306
	VISIT DATE: 10/27/2022

NARRATIVE

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On 12/29/21 at 11:18 am, LPA interviewed Staff #1 (S1). S1 states that, in November 2020, S1 spoke with R1’s POA regarding how to reduce falls. S1 implemented a chair alarm and placed a mat on the floor next to R1’s bed. S1 says R1 has had a bed alarm since move-in. S1 says that R1 did not have a walker at move-in in 2019. S1 says that R1’s doctor made evaluates after each fall and ordered physical therapy. S1 explains that “R1 forgets to use the walker which R1 began using after a fall in February 2021.” S1 says they discussed it with family, and family didn’t want bed rails and didn’t want R1 to go on hospice. S1 says that “R1 falls mostly at night time so I put a night light on.”

On 10/24/22 at 10:57 am, LPA interviewed Witness #1 (W1). W1 says that “R1 had falls but the facility did everything they could.” W1 says R1 “did not fall that often, approximately once every few months” and expresses “they fall” when speaking about older adults.

On 10/27/22 at 2:45 pm, LPA interviewed the administrator. Administrator states that R1 had a tendency to walk at night and sleep in the day. Administrator says that R1’s falls were due to R1 just waking up and not being alert and then R1 forgot to use their walker.

On 10/27/22, LPA reviewed R1 records. On R1’s 2021 assessment, the facility states that “R1 ambulates with a walker, though sometimes R1 forgets, R1 isn’t upset when reminded to use it.” R1 has a dementia diagnosis.

Based on evidence obtained, the allegation “Facility is not providing appropriate assistance for resident’s multiple falls,” is deemed Unsubstantiated at this time. Interviews indicate the facility made efforts to assist R1 with R1’s needs, and that R1’s dementia and night walking made R1 forgetful in using the walker.

On the allegation “Facility did not observe changes in resident's physical health,” the complainant’s concern was that Resident #1 (R1) had “a skin sarcoma the size of a golf ball that went unnoticed until it was nearly inoperable.” To investigate, LPA interviewed the administrator and witness, and reviewed records.

In LPA’s interview on 10/24/22 with W1, W1 states that R1’s growth was about the size of a quarter “earlier on before COVID.” W1 says it was brought it to the facility’s attention “sometime around the holidays 2020” and by that time, it had grown to the size of a half dollar and protruded out. W1 says the facility contacted R1’s doctor who looked at it. W1 says the facility “got on it right away and surgery was performed in April 2021.”

Continued on 9099-C.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20211222092253

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: VISTA ROSA ELDER CARE	FACILITY NUMBER: 405802306
	VISIT DATE: 10/27/2022

NARRATIVE

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On 10/24/22 at 11:57 am, LPA interviewed the administrator. Administrator states that Staff #1 (S1) reported the skin legion to R1’s doctor at the end of December 2020. Administrator spoke with doctor who states R1 had a growth that the doctor attempted to freeze, however, it was not successful in reducing the growth.

On 10/27/22, LPA reviewed resident records. Records indicate that S1 contacted R1’s doctor on 12/9/2020 to inform of R1’s growth. In January 2021, the doctor attempted treat the lesion, in March 2021, R1 saw a dermatologist upon the doctor’s recommendation, and in April 2021, R1 had the growth excised.

Based on the evidence obtained, the allegation “Facility did not observe changes in resident's physical health,” is deemed Unsubstantiated at this time. Interviews and documentation reveal that the facility observed and treated R1’s condition in a timely manner.

On the allegation, “Staff are not assisting resident with using hearing aids,” the complainant was concerned that the facility refused to put R1’s hearing aids in during the day. Complainant relays that the facility is concerned the hearing aids will get lost but says that R1’s mental cognition and communication decreased due to not wearing the aids. To investigate the allegation, LPA interviewed staff, resident, and witness.

When LPA spoke with R1 on 12/29/21, R1 says that they wear hearing aids only when R1 has visitors.

In LPA’s interview with S1 on 12/29/21, S1 says that there was a problem with R1 losing their hearing aids and that family brought string to keep the hearing aids together but R1 took them off. S1 says that in December 2021, family directed S1 to keep them in the medication room because R1 always takes them off. S1 expresses that staff put R1’s hearing aids in when R1 has a visitor.

During LPA’s interview on 10/24/22 with W1, W1 says that R1 would take out the hearing aids and lose them. W1 describes staff as putting them in when people came to visit, such as physical therapists, family, etc. W1 says R1 had a necklace to attach the hearing aids and that seemed to help a bit. W1 says replacement hearing aids cost thousands of dollars and that staff never lost them.

Based on the evidence obtained, the allegation “Staff are not assisting resident with using hearing aids,” is deemed Unsubstantiated at this time. Interviews show that the facility stored R1’s hearing aids so that R1 would not lose them and attached them when R1 had visitors.

No deficiencies cited. Exit interview conducted and the 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: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC9099 (FAS) - (06/04)

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