425802104-9-23-2022-29-AS-KBUY-CJMVES-20220926162251

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802104
Report Date: 09/23/2022
Date Signed: 09/23/2022 04:27:10 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
08/16/2021 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20210816121432

FACILITY NAME:	FOUNTAIN SQUARE OF LOMPOC		FACILITY NUMBER:	425802104
ADMINISTRATOR:	ROBIN MURRAY		FACILITY TYPE:	740
ADDRESS:	1420 W. NORTH AVE		TELEPHONE:	(805) 736-1234
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	130	CENSUS: 63	DATE:	09/23/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Robin Murray, Administrator and Jessica Ramirez, Memory Care Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Due to lack of supervision and care, residents have sustained multiple falls while in care.
Facility is insufficiently staffed to meet the care and needs of residents.
Staff are not responding to residents call button in a timely manner.
Staff are not meeting residents showering needs.
Facility has trash in the hallway.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted a subsequent complaint visit to deliver findings for the above allegations. LPA met with Administrator Robin Murray and Jessica Ramirez, Memory Care Director and explained the reason for the visit.

The investigation was started on 08/19/2021 by LPA Toan Luong. LPA requested documents and interviewed residents on 08/19/2021. LPA Olson conducted a subsequent visit to the facility on 09/21/2022 to continue the investigation. LPA requested documents, interviewed staff, residents, and administrator on 9/21/2022.

On the allegation: Due to lack of supervision and care, residents have sustained multiple falls while in care. It was alleged that residents sustained multiple falls in care due to a lack of supervision. Investigations Branch Investigator Kujawa conducted an investigation into falls on complaint 29-AS-20211028161558. Continued 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: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

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 3

Control Number 29-AS-20210816121432

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: FOUNTAIN SQUARE OF LOMPOC	FACILITY NUMBER: 425802104
	VISIT DATE: 09/23/2022

NARRATIVE

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Staff interviews revealed they did not believe resident’s falls were sustained as a result of neglect or lack of supervision. Residents interviewed stated their needs were met by staff. LPA Olson interviewed staff, administrator, and reviewed incident reports. LPA determined after incident report review and interviews, that the falls sustained were not as a result of lack of supervision. Administrator interview revealed the facility reviewed each resident with multiple falls to try to determine a root-cause of the falls. The number of falls have significantly decreased in the last year since implementing this procedure. In many of the cases reviewed, the falls were due to resident health issues versus a lack of supervision, as it was determined supervision was not needed for walking. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

On the allegation: Facility is insufficiently staffed to meet the care and needs of residents.
LPA reviewed staff schedules, interviewed residents, and interviewed staff and administrator.
All residents interviewed indicated their care needs were met by staff. Staff interviewed indicated they could use more staff at the facility, but in the meantime staff ensured residents’ needs were met through teamwork and by working overtime. In addition to the med tech and caregiver listed on the schedule, the Administrator, nurse, and memory care director step in to provide direct care assistance or medication assistance as needed. Administrator stated they was in the process of hiring and onboarding new staff, and they were having former staff return. Administrator stated they were conscious of staff working too much and could get burned out, so was prioritizing hiring additional staff. LPA requests that the master schedule be updated to show the additional care coverage provided on each shift by management staff. Due to insufficient evidence, the allegation could not be proven at this time. Therefore the allegation is deemed Unsubstantiated at this time.

On the allegation: Staff are not responding to residents call button in a timely manner.
All residents interviewed indicated their needs were met, and staff respond to their call buttons in a timely manner. LPA tested a call button and observed the response time to be 9 minutes. Staff interviewed stated they always respond as quickly as they can to call buttons, and the maximum response time they aim for is 5-10 minutes. LPA reviewed call button logs and observed the response times were mostly less than 10 minutes for the entire month reviewed. Administrator stated management routinely reviews the call button response time log to ensure response times are appropriate, and to look for trends.

Continued on 9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210816121432

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: FOUNTAIN SQUARE OF LOMPOC	FACILITY NUMBER: 425802104
	VISIT DATE: 09/23/2022

NARRATIVE

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Administrator stated they have observed very long response times on occasion, but through investigation it was discovered this happened when residents took their pendants out of the facility and pressed it. In these cases, staff were not able to clear the pendant until the resident physically returned to the facility. Administrator stated they have instructed staff who are actively assisting residents in care to only leave the resident being assisted and respond to the call button if it is safe to do so. Administrator stated if the resident being cared for cannot be left alone, the staff should wait to respond to the other call button or call for other staff to respond. Administrator stated staff were instructed to respond as quickly as possible to residents, but if the resident’s request was not urgent, they could clear the call button and get back to them with the non-urgent item that was needed. Administrator stated they encouraged residents to push the call button again if staff did not respond with the non-urgent need within 5-10 minutes. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

On the allegation: Staff are not meeting residents showering needs.
LPA interviewed staff, administrator, and residents to investigate this allegation. Residents interviewed in Assisted Living and Memory Care indicated their needs were met and the staff assisted them with showers. Residents indicated they never had to skip showers unless they refused. Staff and administrator also stated residents had not missed showers unless they refused or were not present in the facility. Staff and administrator stated when residents refuse, they try again using various methods to ensure the residents receive their showers. Staff and administrator stated they document resident refusals of showers and follow the shower schedule. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

On the allegation: Facility has trash in the hallway. On 09/09/2022, LPA Olson and Cortez toured the facility during an annual inspection. LPA's did not observe any trash in the hallway. LPA Olson observed housekeepers cleaning rooms and placed trash bags in the hallway until they were done cleaning that room, then removed the trash. Residents interviewed indicated the hallway was clean. Staff interviewed stated they had not observed trash in the hallway. Care staff bag up each resident’s trash and place them to be collected once they were done cleaning or changing the resident. However, this posed no hazard to residents. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of report emailed to Administrator.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

LIC9099 (FAS) - (06/04)

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