415600133-9-15-2022-14-AS-JJIN-CL8QEJ-20221116110621

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600133
Report Date: 09/15/2022
Date Signed: 09/15/2022 04:31:38 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/23/2021 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20211223134229

FACILITY NAME:	ATRIA PARK OF SAN MATEO		FACILITY NUMBER:	415600133
ADMINISTRATOR:	CECILIA DAUTH		FACILITY TYPE:	740
ADDRESS:	2883 S NORFOLK ST		TELEPHONE:	(650) 378-3000
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	175	CENSUS: 94	DATE:	09/15/2022
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Chris Waluszko		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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- Resident sustained multiple pressure injuries while in care
- Staff did not ensure a resident is eating accordingly

INVESTIGATION FINDINGS:

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Based on investigation conducted by this Department, it is determined that these allegations are unsubstantiated. Investigation included interviews with facility staff and medical care providers and review of facility and medical records pertaining to client who resided in Life Guidance unit.

Client was admitted on 8/16/21, already receiving home health visits for pressure ulcers. Because client developed new wounds which did not respond to treatment by visiting nurses, she also had weekly appointments at a wound care clinic--beginning in October 2021--where she received assessment and treatment by a nurse practitioner. Staff reported new skin conditions observed to PCP during client's 1st month of residence. Staff were instructed not to change dressings unless they were soiled, due to the nature of the wounds and regular nursing visits. To alleviate pressure on leg and heel, client was recommended to wear a soft boot and use pillows for comfortable positioning. Despite these actions, and because of client's health conditions, she developed multiple pressure ulcers.

According to medical records, client experienced extreme weight loss during her residence at facility, from August 2021. However, there is no documentation of client's weight loss, nor any notes about staff meals. However, there is no documentation of staff encouraging client to eat or giving her other food options. During client's first month of residence, however, home health was aware of client not eating well, and ordered a speech therapist to conduct a swallow evaluation. Based on the postive results, the PCP upgraded client's special diet and ordered a mechanical soft/ground and thin liquid diet.

Athough the allegations may have occurred or are valid, there is not enough evidence to prove the alleged violations did or did not occur.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Audrey Jeung	TELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

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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