425800770-7-21-2022-29-AS-KBUY-CGL2C8-20220722171619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425800770
Report Date: 05/12/2022
Date Signed: 07/21/2022 04:03:57 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
05/09/2022 and conducted by Evaluator Toan Luong

COMPLAINT CONTROL NUMBER: 29-AS-20220509123233

FACILITY NAME:	CRISTINE'S RCFE		FACILITY NUMBER:	425800770
ADMINISTRATOR:	ODOLINA A FLORES		FACILITY TYPE:	740
ADDRESS:	446 E. VENTURA RD.		TELEPHONE:	(805) 937-2141
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	6	CENSUS: 3	DATE:	05/12/2022
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Odolina Flores		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Due to staff, Resident sustained bruises while in care.
Staff handled resident roughly.
Resident not treated with dignity.

INVESTIGATION FINDINGS:

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This is an amended Report. Licensing Program Analyst (LPA) Olson conducted an unannounced complaint visit to issue final findings. Licensing Program Analyst (LPA) Toan Luong conducted the initial 10-day complaint visit to the facility on 5/12/22. LPA Olson met with Administrator Odolina Flores and explained the purpose of the visit.
LPA Luong conducted interviews on 3/21/22 and on 5/12/22 with staff, outside parties, and residents. On 5/12/22, LPA Luong reviewed documents pertinent to the investigation.
LPA Luong interviewed a medical assistant for R1's Primary Care Physician (PCP). This interview revealed that Resident 1 (R1) has a diagnosis of dementia and has hallucinations. Hallucinations have gotten worse since admission to the facility. R1 has difficulties distinguishing hallucinations and reality, causing R1 to try and elope from the facility. The PCP has been R1's physician prior to the diagnose of dementia, and R1 is familiar with the medical team. This interview also revealed that R1 has thin skin that will tear easily due leaking varicose veins and could bruise easily as well.
(Continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

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-20220509123233

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: CRISTINE'S RCFE	FACILITY NUMBER: 425800770
	VISIT DATE: 05/12/2022

NARRATIVE

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This is an amended report. LPA Luong reviewed LIC 602A which revealed R1 is diagnosed with "Senile Dementia with psychosis." LPA reviewed Physicians Visit report dated 2/21/22, which lists the chief concerns reported as "Hallucination ongoing," and "Goal is to reduce paranoia/hallucinations."
On the allegation: Due to staff, Resident sustained bruises while in care. Interviews reveal the incident in question was the same as in complaint control # 29 AS-20220318162054. Interviews reveal that Resident #1 (R1) has a thin skin condition, skin could tear easily like paper and R1 bruises easily because their varicose veins leak. Interviews confirm that R1 had attempted to elope from the facility, and staff tried to prevent the elopement for R1’s safety. Staff tried to deter R1 from leaving by holding R1’s hand, but R1 resisted. When R1 resisted, R1’s thin skin on the arm tore resulting in a skin tear. Based on documentation and interviews, there is not sufficient evidence to prove the allegation, therefore it is unsubstantiated. However, a Technical Assistance Advisory Note was issued to the facility to advise that Staff should not hold hands with Resident 1 to prevent R1 from eloping due to R1’s skin condition. Physically trying to prevent R1 from eloping could be considered a personal rights violation or restraint. Staff need to focus on verbally redirecting R1.
On the allegation: Staff handled resident roughly. It was alleged that R1 had an altercation with the owner after eloping from the facility and the owner grabbed the resident’s wrist. Administrator interview revealed that staff will hold R1’s hand to try and guide them back home. Sometimes R1 will pull away which will cause tearing and bruising to the skin due to R1’s thin skin condition. LPA asked R1 about the incident and R1 responded “she was holding, the other person pulling back, it was me, it was my pressure on her pulling back.” R1 also stated “When I explode I explode, I would exploded several times, it was almost I can’t stop it, the person I’m angry.” Other interviews conducted did not reveal any additional evidence to support this allegation. Based on interviews and documentation, there was not sufficient evidence to support the allegation. Therefore it is deemed unsubstantiated at this time.
On the allegation: Resident not treated with dignity. Reporting party stated that when staff are around residents, they speak in another language which they believe may make residents feel isolated, ignored and/or wonder if they are talking about R1. LPA Luong interviewed residents about how the staff treat them, and if the residents feel uncomfortable if staff speak another language. One resident interviewed stated staff treat them well and they have no concerns with staff communicating in a different language. One resident responded to LPA’s questions but the meaning of the response was not clear or relevant to the questions. The other residents interviewed could not provide responses to these questions. Based on the information obtained, there is not sufficient evidence to substantiate the allegations at this time. Therefore the allegation is deemed unsubstantiated at this time.
LPA conducted exit interview and emailed a copy of this report to the administrator.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

LIC9099 (FAS) - (06/04)

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