405850222-11-21-2024-29-AS-KBUY-DBD4HW-20241125180749

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850222
Report Date: 11/21/2024
Date Signed: 11/21/2024 05:32:42 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
11/04/2024 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20241104143354

FACILITY NAME:	LIFETOUCH THE ELEGANT LIVING RESIDENTIAL HOME CARE		FACILITY NUMBER:	405850222
ADMINISTRATOR:	AQUINO, AMELITA I.		FACILITY TYPE:	740
ADDRESS:	1934 TULIPWOOD DRIVE		TELEPHONE:	(805) 878-3409
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	6	CENSUS: 4	DATE:	11/21/2024
		UNANNOUNCED	TIME BEGAN:	12:58 PM
MET WITH:			TIME COMPLETED:	03:09 PM

ALLEGATION(S):

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Resident developed a pressure injury due to neglect by staff.
Staff are not addressing residents bathing needs.
Staff did not seek timely medical attention for resident in care.

INVESTIGATION FINDINGS:

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At on 11/21/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to issue finial findings to the allegations to this complaint and a case management visit related to this complaint on a separate report during this visit. LPA met with announced who he is and the reason for the visit.
As to the allegation of, “Resident developed a pressure injury due to neglect by staff.”, “Staff are not addressing residents bathing needs.” And “Staff did not seek timely medical attention for resident in care.” It was discovered through interviews, reliable witness (W1) (with current medical license) observation, documentation, and photographic evidence that on 11/14/2024 Resident 1 (R1) was seen by Emergency Room staff and observed two pressure injuries (level 2) about 15 millimeters on the resident’s sacrum. At 8:38am on 11/05/2024, LPA Jeffries contacted W1 who stated, R1 had a stage 2 wound on their lower back (Sacrum) that was not being addressed. Additionally, W1 stated that, R1 had crusted scalp, severe dandruff, crusted skin all over their (R1) body, yeast under the folds of their skin, and dry blood in ears.” On 11/05/2024,
CONTINUED on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

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-20241104143354

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: LIFETOUCH THE ELEGANT LIVING RESIDENTIAL HOME CARE	FACILITY NUMBER: 405850222
	VISIT DATE: 11/21/2024

NARRATIVE

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LPA Jeffries conducted an interview with Facility Administrator and Licensee, Amelita I. Aquino, who stated that R1’s complete resident file was in a green folder and given to the Emergency Medical Technicians (EMTs) when they transported R1 to the hospital on 11/04/2024. Only documentation Administrator had for R1 was R1’s LIC602 (Physician Report), Skilled Nursing Visit Report (SKR) dated 10/29/2024 from Central Coast Home Health Inc. and R1’s Centrally Stored Medication Record (CSMR). On 11/19/2024 LPA Jeffries received an email from Administrator Licensee that R1’s file was lost. On 11/05/2024, LPA Jeffries reviewed documentation of R1’s Physicians Report (LIC602) signed and dated 01/26/2024 which indicated R1 having a primary diagnose of Chronic venous stasis ulcers to BLE's" [medical condition where open sores (ulcers) develop on the lower extremities (BLE's - below the knee) due to poor blood flow in the leg veins], additionally a history of skin break down, also requiring help in Activities of Daily Living (ADL’s) in bathing, grooming, and toileting needs. Both staff stated R1 could walk around in the backyard for exercise, and regularly slept in a recliner. Staff all indicated R1 was able to reposition themselves in the recliner, and transfer themselves from the walker to and from the recliner, and to and from the shower chair. LPA reviewed SKR dated 10/29/2024, indicating a Licensed Skilled Professional attended and dressed two wounds (stage 2) located on the left and right side of R1’s buttock (same area as Sacrum). On 11/18/2024, LPA Jeffries interviewed direct care staff 1 (S1) who stated that R1 had regularly schedule showers every other day. S1 stated that on 11/03/2024, R1 was provided a sponge bath due to mobility issues. S1 stated that every other day prior to 11/03/2024, R1 was provided full assistance with a full shower and bathing routine. S1 stated that R1 had chronic skin conditions that required full showering routine due to scalp and skin condition. S1 stated that there was a dime size wound on R1’s lower back that was treated by Home Health and facility staff twice per week. On 11/05/2024, interviews with S2 and administrator, both stated that R1 would have full shower and bathing assistance every other day, as well as wound care by Central Coast Home Health twice per week. On 11/05/2024 LPA Jeffries attempted to interview 4 of 4 residents at the facility, however no resident was able to complete interview. LPA noted that 4 of 4 residents were clean, free of odors and appeared to be well groomed. LPA attempted to interview R1’s responsible party, but LPA’s calls were not returned. LPA attempted to obtain photographs of R1’s condition from W1, but the photographs were never provided to LPA. LPA attempted to interview home health personnel who visited R1, but personnel declined LPAs requests for interview. LPA also reached out to the licensee for direct phone numbers and names of home health personnel, but licensee was unable to provide the documents.

CONTINUED on LIC9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20241104143354

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: LIFETOUCH THE ELEGANT LIVING RESIDENTIAL HOME CARE	FACILITY NUMBER: 405850222
	VISIT DATE: 11/21/2024

NARRATIVE

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Additionally, the licensee attempted to track down R1’s resident file that was sent with EMTs however was unsuccessful. Based on Interviews, SKR documentation, and observations, home health was treating R1’s pressure injuries, staff assisted R1 with bathing, R1 had a skin condition, and R1 was able to walk around independently. There is not enough evidence to support the allegations of, “Resident developed a pressure injury due to neglect by staff.”, “Staff are not addressing residents bathing needs.” And “Staff did not seek timely medical attention for resident in care.” and are all unsubstantiated at this time. The issues of the licensee losing their original copy of R1’s file and their lack of reporting will be addressed on a separate case management report.

Exit interview, report read, and report provided.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

LIC9099 (FAS) - (06/04)

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