405809547-11-10-2022-29-AS-KBUY-CLFRXH-20221123122446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405809547
Report Date: 11/10/2022
Date Signed: 11/10/2022 05:59:26 PM

Substantiated

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
01/19/2022 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20220119093134

FACILITY NAME:	OAKS AT NIPOMO, THE		FACILITY NUMBER:	405809547
ADMINISTRATOR:	TRACY S. FLAHERTY		FACILITY TYPE:	740
ADDRESS:	177 MARY AVENUE		TELEPHONE:	(805) 723-5206
CITY:	NIPOMO	STATE: CA	ZIP CODE:	93444
CAPACITY:	122	CENSUS: 101	DATE:	11/10/2022
		UNANNOUNCED	TIME BEGAN:	05:18 PM
MET WITH:	Tracy Flaherty, Administrator		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Facility does not have sufficient staff to meet the needs of the residents in care.
Residents are not getting showered or bathed while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) De Leon conducted a subsequent complaint visit to deliver final findings to the facility above. LPA met with Administrator Tracy Flaherty and explained the purpose of the visit.
LPA De Leon conducted the initial complaint visit on 01/26/2022. LPA conducted interviews with staff on 09/14/2022 around 4:00pm and on 11/07/2022 at 4:34pm, 5:29pm, 6:29pm, 6:51pm, and 7:15pm. LPA conducted interviews with residents on 11/02/2022 at 3:03pm, 11/04/2022 at 1:41pm, 1:47pm, 1:54pm, 4:30pm, and on 11/07/2022 at 4:02pm. LPA conducted interviews with witnesses on 11/02/2022 at 3:20pm, 4:00pm, 5:15pm, on 11/03/2022 at 5:27pm, on 11/04/2022 at 4:50pm, and on 11/07/2022 at 2:44pm, 3:29pm, and 3:48pm. LPA collected records on 01/26/2022, 07/26/2022, 09/14/2022 and 11/09/2022. LPA reviewed records on 10/31/2022, 11/02/2022, 11/03/2022, 11/04/2022 and 11/09/2022. Cont. 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

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-20220119093134

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: OAKS AT NIPOMO, THE	FACILITY NUMBER: 405809547
	VISIT DATE: 11/10/2022

NARRATIVE

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On the allegation: Facility does not have sufficient staff to meet the needs of the residents in care. LPA conducted interviews with staff, residents and witnesses which revealed 5/6 staff, 4/6 residents and 6/8 witnesses felt the facility is short staffed in all departments. The facility staffing on Friday-Sunday is very limited causing residents additional wait times and some residents are not receiving services provided in the admission agreement or in their care plans. Residents needs are not being met due to the shortage in staffing. Residents care needs with showers, dressing, hygiene, food service, laundry, and housekeeping are lacking on certain days when staff does not show up to work or staff is not being scheduled sufficiently. Based on the evidence this allegation is deemed Substantiated at this time.

On the allegation: Residents are not getting showered or bathed while in care. LPA conducted interviews with 5/6 staff, 5/8 witnesses and 2/6 residents which revealed when staff are short handed showers are not getting completed as scheduled on days when the facility gets staff call off’s or No shows. 5/6 staff stated that staffing is not being scheduled sufficiently to get all residents services completed as scheduled, the residents are made to wait longer or refused due to being late and skip showers until the next scheduled date. Based on the evidence this allegation is deemed Substantiated at this time.

Exit interview conducted, deficiencies cited, copy of report and appeal rights emailed to Administrator.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220119093134

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: OAKS AT NIPOMO, THE	FACILITY NUMBER: 405809547
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/10/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/17/2022 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	(a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs….facility require such additional staff for the provision of adequate services. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to hire additional staff, schedule adequate staffing everyday of the week, review and train staff on regulation 87411, provide an up to date LIC 500, staffing schedules, list of new
	8 9 10 11 12 13 14	Based on interviews with staff, witnesses and residents the licensee failed to comply with the regulation above Facility is insufficiently staffed to meet all the residents needs which poses and immediate Health, Safety and personal rights risk to residents in care.	8 9 10 11 12 13 14	hires with titles to CCL monthly for 3 consecutive months.
Type A 11/24/2022 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	(f)Basic services shall at a minimum include:(4)Personal assistance and care as needed by the resident…with those activities of daily living such as dressing, eating, bathing…This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agreed to review contracts for bathing/showering needs, make a shower schedule, follow that shower schedule, late/not completed due to staffing must be documented and refusals documented
	8 9 10 11 12 13 14	Based on interviews with staff, witnesses and residents the licensee failed to comply with the regulation above residents are not getting bathing/showering needs met which poses and immediate Health, Safety and personal rights risk to residents in care.	8 9 10 11 12 13 14	with a reason, facility must hire enough staff to meet the residents shower schedule and provide documentation to CCL.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

LIC9099 (FAS) - (06/04)

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