425801657-3-7-2022-29-AS-KBUY-CCEVEL-20220311152230

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425801657
Report Date: 03/07/2022
Date Signed: 03/07/2022 03:11:22 PM

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
01/04/2022 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20220104123653

FACILITY NAME:	LA SALLE CARE HOME INC.		FACILITY NUMBER:	425801657
ADMINISTRATOR:	MERLA P. VENTURA		FACILITY TYPE:	740
ADDRESS:	1603 LA SALLE DRIVE		TELEPHONE:	(805) 287-9570
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	6	CENSUS: 2	DATE:	03/07/2022
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Merla Ventura, Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff refused to accept resident back from the hospital

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted an unannounced complaint visit to issue final findings.
LPA Diaz conducted the investigation, and reviewed facility documents, conducted interviews with staff, clients and the Power of Attorney (POA). LPA interviewed staff on 1/04/22 at 9:16am and on 2/08/22 at 2:38pm. LPA interviewed residents on 2/10/22 at 11:00am. LPA interviewed the POA on 2/8/22 at 3:15pm.

On the allegation: Facility staff refused to accept resident back from the hospital. The Administrator stated on 12/28/21 Resident 1 (R1) was shouting in pain due to a Urinary Tract Infection (UTI), and therefore was taken to the emergency room (ER). R1 was ready to be discharged from the hospital but the Administrator was concerned about R1’s disruptive behavior and the impact it was having on the other residents. The ER Nurse had a discussion with the Administrator and explained that R1’s condition was not severe enough to be admitted at the hospital. The Nurse also stated that the Administrator needed to take the resident back to the facility and therefore the administrator accepted R1 back to the facility. Cont on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022

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-20220104123653

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: LA SALLE CARE HOME INC.	FACILITY NUMBER: 425801657
	VISIT DATE: 03/07/2022

NARRATIVE

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According to Staff 1 (S1), R1 was quiet when they returned to facility but ultimately became moody and disruptive again. S1 also stated that R1 regularly has urinary problems and screams inside the facility.
The POA stated that R1 is declining in health and that R1 is a difficult resident. The POA confirmed R1’s defiant behavior inside the facility and stated that R1 is aggressive towards the Administrator. The POA also stated that R1 has always been accepted back to the facility when discharged from the hospital. Residents interviewed stated that they are happy living at the facility and have no complaints with the facility services. LPA made multiple attempts to contact the ER nurse but was unable to reach them. Based on the interviews and records reviewed, the allegation is deemed unsubstantiated at this time.
Exit interview, report given

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC9099 (FAS) - (06/04)

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