421700160-6-1-2023-29-AS-KBUY-CSQRTU-20230612131856

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 421700160
Report Date: 06/01/2023
Date Signed: 06/01/2023 01:10:06 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
04/20/2023 and conducted by Evaluator Brian Phillips

COMPLAINT CONTROL NUMBER: 29-AS-20230420091544

FACILITY NAME:	CASA DORINDA		FACILITY NUMBER:	421700160
ADMINISTRATOR:	BRIAN MCCAGUE		FACILITY TYPE:	741
ADDRESS:	300 HOT SPRINGS RD.		TELEPHONE:	(805) 969-8011
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93108
CAPACITY:	360	CENSUS: 337	DATE:	06/01/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Therese Brown, Director		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Residents are left in soiled diapers for an extended amount of time
Staff do not provide proper medication assistance to residents in care
Staff do not have adequate medication training
Resident records are not properly maintained

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced subsequent complaint visit to issue final findings for the allegations above. LPA arrived at the facility and announced the purpose of the visit. LPA met with Therese Brown, Director of Health Services.

On the allegation: Residents are left in soiled diapers for an extended amount of time. It is alleged that residents have been observed walking around the facility with diapers full of urine and have also been left in soiled diapers overnight.

On 04/26/2023, LPA interviewed staff members and residents in the facility. No staff member nor resident confirmed the allegation. Residents interviewed stated they were not left in a soiled state for a long period of time, and staff help when needed.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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 4

Control Number 29-AS-20230420091544

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CASA DORINDA	FACILITY NUMBER: 421700160
	VISIT DATE: 06/01/2023

NARRATIVE

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Staff interviewed stated they had not observed any residents soiled for a long period of time, and when a resident is soiled staff immediate assist the resident with incontinence care ana clothing change if needed. LPA did not observe any evidence of the allegation while at the facility.

Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, it is deemed Unsubstantiated at this time.

On the allegation: Staff do not provide proper medication assistance to residents in care. It is alleged that staff members do not give residents their correct medications.

On 04/26/2023, LPA reviewed the Centrally Stored Medication and Destruction Record for the assisted living portion of the facility. LPA also obtained copies of resident medication records and physician order reports for residents, maintained in each resident’s record/file. LPA observed that all the correct/proper medications were logged as having been given to each resident, and an audit of the actual medications stored in the assisted living portion of the facility matched the records maintained by the facility.

Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, it is deemed Unsubstantiated at this time.

On the allegation: Staff do not have adequate medication training. It is alleged that staff members who assist the residents with medication do not have any training.

On 04/26/2023, LPA interviewed staff members and obtained records/documentation of medication training for staff members authorized to dispense medication and/or assist with giving medication to the residents. LPA also reviewed the Training Requirements for RCFEs relating to the hours of medication training required by staff members who assist or dispense medication to residents. Documentation of staff medication training included a competency checklist in setting up medications, assisting with oral/buccal/subdermal/sublingual/eye drop/topical medications, hand washing, assisting with inhalers/nasal sprays etc. The facility switched from an older documentation of medical training for staff to a modern computerized online video software system uniform for all employees.

Continued on 9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20230420091544

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CASA DORINDA	FACILITY NUMBER: 421700160
	VISIT DATE: 06/01/2023

NARRATIVE

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Therefore, the facility has both medication training records from an online source and from the facility itself using qualified trainers. S1 told the LPA that all staff that are required to help with medication for residents undergo a training process that is an online/video system. This program offers online, staff compliance training based on published accreditation standards. It is designed to ensure staff competence and meets OSHA and other regulatory requirements. S1 provided LPA a copy of the manual to the medication training program for staff at the facility. S3 provided information about the training process to dispense or assist with medications for residents. S3 told LPA about the guidelines, shadowing, online learning, procedures, and medication management/assistance that meet Title 22 Regulations. S3 provided LPA a form that staff receive titled 24-hour medication aide training verification form, and multiple certificates of completion regarding medication training. All staff members whose records were reviewed for assisted with medication have documented records of adequate medication training.

Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, it is deemed Unsubstantiated at this time.

On the allegation: Resident records are not properly maintained. It is alleged that that staff members of the facility log incorrect medications and/or physician orders in the resident records.

According to interviews, in March 2023 a resident was ordered by a physician to have a medical scan/test at a hospital, but the administrator sent the resident to the appointment with incorrect resident records. This caused the resident discomfort, distress, and a refusal to go back for the scan/test after the administrator corrected the resident records. On 04/26/2023, LPA reviewed electronically submitted physician orders for the resident from 03/24/2023 and 03/29/2023. LPA also reviewed the Requisition for Services for a medical scan/test, and the documented physician report of consultation for the resident from 03/14/2023. All records are properly maintained for the resident by the facility, there are no missing or incomplete records regarding medical scans/tests for the resident. The facility maintains the records of clients in assisted living and memory care in hard copy folders, segmented by document type. LPA reviewed the resident records and they were maintained with all required regulatory and resident information. The information in the documents revealed doctor’s orders for the medical test/scan, and asked that the scan be performed on both legs of R1. Based on interviews and documentation, there was no evidence that the facility provided incorrect information to R1’s doctor about which leg should have been scanned/assessed. Continued on 9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20230420091544

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CASA DORINDA	FACILITY NUMBER: 421700160
	VISIT DATE: 06/01/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, it is deemed Unsubstantiated at this time. Exit interview conducted, copy of investigation findings emailed and printed.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC9099 (FAS) - (06/04)

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