425801723-10-10-2024-29-AS-KBUY-DACLW4-20241024090632

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425801723
Report Date: 10/09/2024
Date Signed: 10/10/2024 04:41:24 PM

Substantiated

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
10/07/2024 and conducted by Evaluator Brian Phillips

COMPLAINT CONTROL NUMBER: 29-AS-20241007145012

FACILITY NAME:	PRIMROSE		FACILITY NUMBER:	425801723
ADMINISTRATOR:	DOROTHY BERGER		FACILITY TYPE:	740
ADDRESS:	4630 SONG LANE		TELEPHONE:	(805) 310-6996
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	14	CENSUS: 13	DATE:	10/09/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Dorothy Berger, Administrator and Margie Halsell, Licensee		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff are not providing resident's authorized representative with copies of resident's records

INVESTIGATION FINDINGS:

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This is an amended report
On 10/09/2024, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced complaint investigation visit to the facility above to deliver final findings for the above allegations. During today’s visit, LPA Phillips met with Administrator Dorothy Berger and Licensee Margie Halsell, and explained the reason for the visit.

On the allegation: Staff are not providing resident's authorized representative with copies of resident's records. It is alleged that when Resident #1 (R1) was discharged from the facility above on 09/30/2024, their Representative asked the facility for a copy of R1’s Weight Log but did not receive an updated document with entries for all weeks R1 was in care. The allegation states that if the facility is logging the information, then it should be in R1’s file and their Representative should get copies. According to the allegation, the California Code of Regulations (CCR) Title 22 §87468.2(a)19 states that the Representative of R1 should have copies of all records including an updated weight log. Continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

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-20241007145012

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: PRIMROSE	FACILITY NUMBER: 425801723
	VISIT DATE: 10/09/2024

NARRATIVE

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This is an amended report. On 9/30/2024, R1 was discharged from the facility above by their representative/responsible party. Prior to the date of discharge, R1’s representative requested copies of R1’s facility file documentation. On 09/18/2024, R1’s representative requested and received facility documentation including a Weekly Client Weight Record for the weeks of 06/26/24-09/18/2024 with documented entries for all weeks R1 was in care at the facility except the last week prior to discharge. On 10/04/2024, the Representative of R1 showed LPA evidence of having obtained the Weekly Client Weight Record with documented entries through the week of 09/18/2024. The allegation stems from the fact that the document obtained by R1’s representative is missing one (1) entry in the weekly client weight record for the last week R1 was in care at the facility. R1’s representative believes they are entitled to an updated weekly client weight record with all weeks R1 was in care at the facility documented. The facility provided R1's representative their weight record from admission to discharge except for the last week the resident was in care (documented weeks of 6/26/2024-9/18/2024). At the time of the request on 09/18/2024, this weight log was current. R1’s representative requested and received R1’s facility file information again on 09/29/2024. At the time of this second request, the Weekly Client Weight Record was still current. On 10/02/2024, after R1 had been discharged from the facility, their representative sent a telephone text message to the facility contact number requesting an updated Weekly Client Weight Record document for R1 with their recorded weight taken on the date of discharge (09/30/2024). According to staff interviews by LPA, this text message was not read until up to four (4) days later since R1 no longer resided at the facility, and as communications, attitude, and behavior by R1’s representative had interfered with and undermined the Staff at the facility. Administrator stated when they read the text message, they thought it was referring to documents that were already provided to the representative. Administrator did not understand the representative wanted an additional updated document until LPA arrived at the facility on the complaint. Documentation of a Care Meeting between the facility and R1’s representative on 07/30/2024 stated that Staff felt harassed while doing their job due to rude comments, forceful demeaning tones, aggressive language, and contradictory demands by R1’s representative on a regular basis.

The facility is not mandated by Community Care Licensing Division (CCLD) to provide documentation of the resident’s weight record unless there is any unusual weight gain or unusual weight loss. Resident weight logs/records are not technically required to be maintained in a resident’s file in general unless there is any unusual weight gain or unusual weight loss. The CCLD regulations only state that when changes such as unusual weight gains or losses are observed, the facility shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's representatives. Contd. 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20241007145012

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: PRIMROSE	FACILITY NUMBER: 425801723
	VISIT DATE: 10/09/2024

NARRATIVE

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This is an amended report. LPA found no evidence that there was an agreement to pay more for weekly weight records of R1 by the facility and the Representative of R1.

Through record review of R1’s documented facility file, LPA observed that weight gains/losses by R1 have been documented by the facility in R1’s file which was provided to R1's representative upon request on 09/18/2024 and 09/29/2024. R1’s Physician’s Report for Residential Care Facilities for The Elderly (RCFE), signed and dated 02/24/2024, indicates R1 needs a low sodium diet with no milk. The Pre-Placement Appraisal Information for R1, signed/dated by R1’s Representative on 06/05/2024 and the Licensee on 06/10/2024, indicates R1 needs service of a special diet/observation of food intake. This consists of a low sodium and low starch diet. Admission considerations for R1 state that R1 has had recent weight gain/loss caused by fluid retention prior to admission to the facility. Progress notes from a 09/05/2024 primary care physician (PCP) visit by R1 indicate treatment includes low sodium/low cholesterol/low fat diet and exercise. The PCP progress notes from 09/05/2024 also document that R1 has denied any vomiting or weight loss. R1’s current weight was recorded and reviewed by their PCP on 08/05/2024 and 09/05/2024 in Medicare wellness visits with no concerns identified. In a documented statement by R1 during a PCP visit on 09/05/2024, they stated they have no lack of food and no concerns about food. A review of patient symptoms for R1 by their PCP on 09/05/2024 indicated a negative for unintentional weight loss.

The complaint allegation states that California Code of Regulations (CCR) Title 22 §87468.2(a)19 means that the Representative of R1 should be entitled to an updated Weekly Weight Record for R1. This regulation states that residents in privately operated residential care facilities for the elderly shall have the personal rights to have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days. This regulation applies to records documented by the facility and kept in the resident file. The Representative of R1 requested and received the Weekly Client Weight Record document for R1 provided by the facility on 09/18/2024 and 09/29/2024, which were current at the time they were provided. However, R1’s representative again requested a current updated Weekly Client Weight Record for R1 on 10/02/2024 which was not provided by the facility until a complaint investigation visit by LPA on 10/09/2024.

On 10/09/2024 during this complaint investigation visit by LPA, the facility provided documentation of the weight of R1 on 09/30/2024 for the Weekly Client Weight Record. LPA observed a facility staff member send this updated document to the Representative of R1. Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20241007145012

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: PRIMROSE	FACILITY NUMBER: 425801723
	VISIT DATE: 10/09/2024

NARRATIVE

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This is an amended report. R1's representative had previously requested and received a current Weekly Client Weight Record from the facility on 09/18/2024 and 09/29/2024. There is documented evidence of R1’s representative requesting the Weekly Client Weight Record for R1 on 09/18/2024 and 09/29/2024 through email communications with the facility, prior to the weighing of R1 on 09/30/2024. Copies of the current Weekly Client Weight Record were provided to R1’s representative at the time of the requests. There is additional evidence that the representative of R1 requested an updated Weekly Client Weight Record to show the weight of R1 on 09/30/2024 through a text message to the facility on 10/02/2024. This updated document was not provided to R1’s representative until 10/09/2024 through a complaint visit by the LPA.

Based on the information gathered, there is sufficient evidence to prove the alleged violation occurred. Therefore, the allegation is Substantiated.

Exit interview conducted. Technical Violation issued. Copy of report provided to the facility.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC9099 (FAS) - (06/04)

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