425802110-9-19-2023-29-AS-KBUY-CW62PW-20230929173503

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802110
Report Date: 09/19/2023
Date Signed: 09/19/2023 03:06:07 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
05/16/2023 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20230516153220

FACILITY NAME:	A CASA RHODA 3		FACILITY NUMBER:	425802110
ADMINISTRATOR:	DEMONTEVERDE, NORMAN RHODE		FACILITY TYPE:	740
ADDRESS:	126 SANTA ANA AVENUE		TELEPHONE:	(805) 683-0980
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93111
CAPACITY:	6	CENSUS: 6	DATE:	09/19/2023
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Rhoda Demonteverde, Director		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not meet resident’s care needs resulting in pressure injury.
Facility staff did not assist resident with physical therapy.
Facility staff did not meet resident’s dietary needs
Facility does not have sufficient staffing
Resident does not have a current appraisal
Facility staff did not involve responsible party in physician contacts
Administrator is not present in the facility an adequate amount of time
Facility is not providing adequate laundry services

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Jenny Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegations above. LPA met with Rhoda Demonteverde, Director and explained the purpose of the visit. LPA interviewed Reporting Party on 5/23/23, Administrator, staff, and residents on 5/23/23, Director on 5/23/23 and 5/31/23, Physical Therapist on 9/12/23 and Service Coordinator on 9/18/23.

On the allegation: Facility staff did not meet resident’s care needs resulting in pressure injury. It was alleged that Resident 1 (R1) developed a stage 2 pressure injury on 5/17/23. Reporting Party (RP) stated they believe it wouldn’t have gotten so bad if staff assisted R1 with getting up because R1 scoots off the bed. LPA reviewed R1’s records and interviewed staff. R1’s records reveal on 12/19/22 R1 went to Urgent Care due to a skin tear on right buttock. Urgent Care documents dated 12/19/22 state “It’s assumed that (R1) scratched their buttock overnight.” On 12/28/22 R1 saw their Primary Care Physician (PCP) and notes indicate “pressure sore right buttock, approximate stage II.”
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: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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 6

Control Number 29-AS-20230516153220

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: A CASA RHODA 3	FACILITY NUMBER: 425802110
	VISIT DATE: 09/19/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

On 5/11/23 R1 went to urgent care chief complaint is “wound check” and “bleeding/bruising on bilateral lateral thighs; (family) reports patient has a hx of self-injurious behavior.” The notes state “pressure injury of skin of sacral region, unspecified injury stage.” On 6/13/23 R1 went to Urgent Care. Notes state, “sore on the R medial mid buttock present for some time. It had healed per Home Health and then recently reopened.” The wound was at Stage 1. On 6/14/23 R1 was seen in the Emergency Department for “evaluation of scratches to the lower extremities, pressure sores to the coccyx, and potential toe injuries.” On the notes under History of Present Illness “They report multiple bruises and scratches to the LLEs as well as L shoulder; they additionally note a stage 1 pressure ulcer to the coccyx present x 1 year. The pt describes that (they) sometime scratches (their) legs out of frustration or anger and denies harm from others.” An email from R1’s home health nurse dated 6/13/23 at 10:05am states, “Patient is noted to have long fingernails and scratches to hips and thighs…patient is noted to be scratching buttock during wound care…Patient is noted to drag buttock along seat while attempting to stand…Patient was on services 12/20/22-1/19/23 for wound to right buttock. RN saw patient 2x weekly for 3 weeks before wound was healed.” R1’s physician’s report dated 3/17/23 and 10/28/19 indicates R1 can independently transfer to and from bed. R1’s appraisal/needs and services plan dated 3/21/23 indicates R1 uses a walker, moves slower, has gait disturbances, desires to regain their strength to discontinue the use of a walker. R1’s previous appraisal/needs and services plan dated 9/11/22 indicates R1 may be slower to walk with a walker, has gait disturbances sometimes, wants to regain strength to walk without the walker in the bedroom, likes to do range of motion exercises and may use weights. Neither the appraisals nor the physician’s report indicates R1 needed staff assistance to ambulate and transfer, and R1 was trying to regain strength to become more independent. Based on the information obtained the allegation is deemed Unsubstantiated at this time.

On the allegation: Facility staff did not assist resident with physical therapy. It was alleged staff did not support R1 with physical therapy (PT) exercises the PT instructed R1 to do after visits. According to the RP, R1’s placement agency paid facility staff to ensure R1 was helped with the exercises. R1’s appraisal/needs and services plan dated 9/11/22 indicates R1 likes to do range of motion exercises and may use weights. LPA reviewed R1’s PT notes, which indicated the exercises R1 did while the PT was present. LPA interviewed staff that stated they help all residents with PT exercises. Administrator stated that R1 has improved since they started PT and that progress would only be possible if staff were helping and assisting with PT exercises. LPA interviewed R1’s Physical Therapist who stated R1 did improve but wasn’t under the impression it was staff’s responsibility to help R1 with PT exercises.
Continued on 9099-C (pg 3)

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 29-AS-20230516153220

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: A CASA RHODA 3	FACILITY NUMBER: 425802110
	VISIT DATE: 09/19/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

PT stated R1 had a main staff member that was present some of the sessions and knew how to do the exercises but never gave that staff “homework” or instructed them to do certain exercises every day. PT stated they were under the impression R1’s family member was going daily to help R1 with the exercises and was mainly the person involved in the PT sessions. LPA interviewed R1’s Service Coordinator (SC) who stated on 4/10/23 they met with the family and facility to discuss staff increasing R1’s physical exercise to 12 minutes twice a day over the next 90 days. SC stated that this was to help with R1’s constipation and had nothing to do with PT. SC stated they were not aware R1 had PT and had no notes about R1 receiving PT and any issues about staff not assisting with PT. Based on the information obtained the allegation is deemed Unsubstantiated at this time.

On the allegation: Facility staff did not meet resident’s dietary needs. It was alleged that R1 has a special high fiber diet including no processed foods prescribed by the doctor and the facility is not following it, causing R1 to be constipated. LPA interviewed staff who stated that they try to give R1 the correct foods and have a special diet/menu for them. Staff stated that other residents make comments about R1’s food, and R1 doesn’t like the foods in their special diet and asks to be served what everyone else is having. Staff state they want R1 to eat, know they have the right to ask for and eat what they want, but they always try to offer fibrous foods. Director provided LPA with R1’s special menu which includes high fiber foods. LPA observed residents eating a healthy lunch on 5/23/23 with high fibrous food, including grapes, olives, salad, and beans. On 5/23/23 LPA observed an adequate amount of perishable, fresh foods including fruits, vegetables, and meats. LPA did not observe a large amount of highly processed frozen food. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

On the allegation: Facility does not have sufficient staffing. It was alleged that there are only 2 staff for 6 residents, R1 requires full assistance with dressing, sitting, getting up and cleaning themselves and has recently been having behaviors like throwing things and scratching staff. RP believes this is because staff are not paying enough attention to R1 and they are exhibiting new behaviors to receive attention from staff. RP also stated that staff denied R1 to go outside on the patio because there were “not enough staff” to watch them. LPA interviewed staff and reviewed resident records. Another resident is a 2 person assist and there are always at least 2 staff working. Director interview revealed that there are 3-4 administrators that come in constantly to check on staff and residents and always available to come assist staff when needed. Director stated that all resident needs are being met but sometimes a resident may have to wait a few minutes for assistance if staff are busy. Continued on 9099-C (pg 4)

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 29-AS-20230516153220

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: A CASA RHODA 3	FACILITY NUMBER: 425802110
	VISIT DATE: 09/19/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Director stated staff are mostly able to assist with all residents needs immediately without calling the backup Administrators. LPA interviewed residents who stated their needs are met and there is enough staff to assist them. LPA interviewed R1’s Service Coordinator (SC) about any staffing concerns. SC stated staff tried their best to meet R1’s needs and had no concerns about staffing. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

On the allegation: Resident does not have a current appraisal. It was alleged that R1 has an outdated care plan/appraisal that does not reflect R1’s current needs. RP stated recently the facility tried to update it again but it was inaccurate due to it not covering incontinence, physical therapy, R1’s new diet, or constipation. LPA reviewed appraisal/needs and service plans, and all residents had a needs and service plan updated within the last year as required. R1 had one dated 02/25/22 and signed by the licensee on 02/25/22, and one on 09/11/2022 signed but the Licensee on 09/26/22. There was another one dated 03/21/23 but it is unsigned. There is a copy dated 03/18/23 with writing on it from R1’s family member. LPA interviewed Director who stated they made a second attempt to get it signed in March during R1’s annual review. They stated R1’s Service Coordinator and family was here to try and create a new plan for R1. Previously they had updated the plan in January but R1’s family member refused to sign it. R1’s family member sent notes with corrections that the facility did not agree with so the Director contacted the doctor to figure out an appropriate care plan for R1. Director states it’s been hard to coordinate a time for everyone to meet and stated they feel that anything they do is wrong according to the family member. For example under Physical Health “low carb diet for weight management” was listed. Handwritten notes state this is outdated and should indicate high fiber diet for constipation as mentioned in 12/28/22 Urgent Care visit. Although the facility and family did not totally agree about the care plan revision, there still was an updated appraisal completed timely. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

On the allegation: Facility staff did not involve responsible party in physician contacts. It was alleged that the Administrator contacted R1’s doctor without informing or involving the responsible party and wanted to give R1 more medication. LPA interviewed R1’s responsible party who stated that they only gave the facility consent to handle and communicate with R1’s doctor for one year. RP stated that expired 1/31/21 and the Administrator is contacting the doctor without their consent. LPA interviewed Director who stated that R1 was exhibiting increased behaviors lately and informed the doctor about the “change in condition” and requested a medication evaluation. R1’s doctor told the Director to contact them every time there is an episode, so they know what’s happening with R1.
Continued on 9099-C (pg 5)

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 29-AS-20230516153220

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: A CASA RHODA 3	FACILITY NUMBER: 425802110
	VISIT DATE: 09/19/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Director admitted they weren’t aware the consent for release of client/resident medical information expired, but Regulation 87466 states the facility needs to contact the physician with any changes in physical, mental, emotional or social functioning including a change of condition, so they did. Director also confirmed they kept R1’s responsible party updated about changes in R1’s condition as well. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

On the allegation: Administrator is not present in the facility an adequate amount of time. It was alleged that the Administrator on record (Norman Demonteverde) was not present at the facility. However, when LPA contacted the RP, RP stated they thought Norma Demonteverde was the Administrator and they are not present in the facility an adequate amount of time and sees Norman often.
This complaint was received on 5/16/23, and CCL received notification to change the facility’s administrator on 5/22/23. LPA interviewed Director who stated they recently changed Administrators because Norman is running home #2, but comes to home #3 often to fix things. Director stated there are 4 Administrators, including themselves, that helps oversee the 5 facilities and all Administrators in the home often. Director said they stop by daily for a few hours to check on every resident and staff in every home. LPA interviewed residents who stated Norman is always around helping and they sometimes see Norma. They also stated they see Rhoda and Joyce, other Administrators, helping in the facility. LPA interviewed R1’s Service Coordinator (SC) about any staffing concerns. SC stated that Rhoda and Norma were always available for meetings and responded timely to emails and calls and had no concerns about them being present in the facility. The facility sends in required documentation to CCL timely, and all facility documentation reviewed was up to date. There are no other indications an administrator is not present an adequate amount of time to manage and oversee the facility. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

On the allegation: Facility is not providing adequate laundry services. It was alleged that the washing machine has been broken for 2 months and family have to pick up the laundry and clean residents clothes and sheets. On 5/23/23 LPA observed the washing machine to be functioning but the lid was cracked and staff stated they have to put something heavy on the lid so that it sealed and it didn’t leak when spinning. Administrator stated the washing machine was broken for a few weeks earlier in the year and staff took the laundry to the other facility. The facility contacted someone to look at the broken washing machine timely, but they had to wait a few weeks for the replacement part. However, laundry was still completed by using the other facility’s washing machine. Continued on 9099-C (pg 6)

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 29-AS-20230516153220

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: A CASA RHODA 3	FACILITY NUMBER: 425802110
	VISIT DATE: 09/19/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA viewed the invoice for a new replacement lid for the washer and that it fixed when LPA visited on 9/19/23. LPA interviewed residents who stated there were no issues with laundry and their clothes/sheets are always cleaned. LPA interviewed Staff who stated R1’s family member offered to take R1’s laundry home and wash it because R1 was having a lot of incontinence. Staff also stated R1 changes their clothes 5 times a day due to a behavior, and has heavy blankets that R1’s family members provide. R1’s family member always offers to help with laundry so they send those home with R1’s family to wash since they come by daily. A staff stated R1’s heavy blankets makes a noise when they wash it so they send the blankets home with R1’s family member to wash. R1’s family member confirmed they offered to assist with the laundry. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of the report issued.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC9099 (FAS) - (06/04)

Page: 6 of 6