425802104-9-12-2021-29-AS-KBUY-C7GNJF-20211004103017

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802104
Report Date: 09/12/2021
Date Signed: 09/12/2021 07:10:29 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
10/13/2020 and conducted by Evaluator Arien Diaz

COMPLAINT CONTROL NUMBER: 29-AS-20201013082018

FACILITY NAME:	FOUNTAIN SQUARE OF LOMPOC		FACILITY NUMBER:	425802104
ADMINISTRATOR:	KENNY ESPINAL		FACILITY TYPE:	740
ADDRESS:	1420 W. NORTH AVE		TELEPHONE:	(805) 736-1234
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	130	CENSUS: 64	DATE:	09/12/2021
		UNANNOUNCED	TIME BEGAN:	02:12 PM
MET WITH:	Patricia Campos		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Residents are missing medications
Residents medications are not being refilled timely
Residents are not receiving their medications

INVESTIGATION FINDINGS:

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LPA Diaz reviewed facility documents and conducted interviews with staff, and residents. LPA interviewed staff on 8/13/21 at 5:17pm and on 8/15/21 at 11:50am, 12:23pm, 12:50pm, 1:16pm, 1:59pm, 4:08pm, and on at 4:45 pm. LPA interviewed staff on 8/16/21 at 10:36am 11:17am and 6:45pm. LPA interviewed clients on 8/18/21 at 4:14pm, 4:20pm, 4:37pm. LPA interviewed clients on 8/19/21 at 4:27pm, and 4:54pm. LPA interviewed clients on 8/22/21 at 1:17pm, 1:26pm, 1:35pm, 1:40pm and on 3:56pm. LPA conducted a medication audit on 09/12/21.

On the allegation: Residents are missing medications. 10 out of 10 Medical Technicians (MedTech’s) stated that they have never experienced missing medications and stated there are indicators that would make them aware of missing medications. 10 out of 10 MedTech’s stated all medications are distributed, documented, and there are no missing medication issues.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Arien Diaz	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2021

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-20201013082018

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: 09/12/2021

NARRATIVE

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The electronic mar indicates the residents name, the time administered, the dosage, refusal of medication, or anything involving medication. Most residents use the bubble pack therefore it is easy to see if medications are missing. All MedTech’s stated, refills are ordered 7 days in an advance. All MedTech’s stated If residents were not receiving their medications caregivers would be aware due to a change in behavior. S1 stated they are unaware of missing medications and would report any unusual behavior to the MedTech’s. If medications were missing, the MedTech’s would inform the nurse, the administrator and the family. 10 out of 10 residents stated, the MedTech’s provide medication and their medication is always available. Residents also stated that the MedTech’s are dependable and do their job well. LPA reviewed the MAR and a sample of Centrally stored medication and observed no medications missing. Based on observations, data collected from interviews, the allegation Residents are missing medications is deemed unsubstantiated at this time.

On the allegation: Residents medications are not being refilled timely. 10 out of 10 MedTech’s stated there is strong communication among the MedTech’s, and medication is ordered 7-10 days in advance. All MedTech’s stated they would be aware if medications were low because the electronic mar is reviewed daily. If the facility is experiencing ordering issues, MedTech’s will reach out to the doctor, because the doctor is good at faxing authorizations back to the facility. The MedTech’s can also call the pharmacy and ask for a temporary 7-day supply. According to the MedTech’s, all staff will notify MedTech’s with unusual behavior among the residents or a change of condition. 10 out of 10 MedTech’s stated they must report any ordering issues to the nurse, the resident’s family and the facility supervisor/administrator. 10 and 10 MedTech’s stated they order medication timely and there are no issues with reordering medications. 10 out of 10 residents stated their medication is always available and never missing. LPA reviewed the MAR and a sample of Centrally stored medication and observed medication were reordered timely and no medications were missing. Based on data collected from interviews, the allegation Residents medications are not being refilled timely is deemed unsubstantiated at this time.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Arien Diaz	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2021

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20201013082018

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: 09/12/2021

NARRATIVE

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On the allegation: Residents are not receiving their medications. 10 out of 10 MedTech’s stated all medications are always distributed, documented, signed off by MedTech’s. Most residents use the bubble pack therefore it’s easy to see if medications have not been administered. The MedTech’s review the electronic mar and communicate with the MedTech on the prior shift. According to all staff, MedTech’s would be aware if medications were not administered because the Mar is reviewed daily. The electronic mar also highlights specific residents that have not received their mediation thus making staff aware while reviewing the Mar. 10 out of 10 MedTech’s stated there are no issues assisting residents with medications at the facility. 10 out of 10 residents stated MedTech’s always provide medication, and the residents take their medication. Residents also stated that the MedTech’s are dependable and do their job well. LPA reviewed the MAR and Centrally stored medication and observed that medications were given as prescribed. Based on observations data collected from interviews, the allegation Residents are not receiving their medications is deemed unsubstantiated at this time.

An exit interview was conducted, emailed of the report was given.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Arien Diaz	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2021

LIC9099 (FAS) - (06/04)

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