425802130-2-22-2023-29-AS-KBUY-CPFS7J-20230227123734

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802130
Report Date: 02/22/2023
Date Signed: 02/22/2023 12:43:30 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
11/04/2022 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20221104164118

FACILITY NAME:	DOCTOR'S RESIDENTIAL CARE FACILITY		FACILITY NUMBER:	425802130
ADMINISTRATOR:	GILL, NATASHA		FACILITY TYPE:	735
ADDRESS:	925 W. CLARENCE CT.		TELEPHONE:	(805) 623-5490
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY:	4	CENSUS: 3	DATE:	02/22/2023
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Natasha Gill, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility staff did not provide medical attention for resident.
Facility staff denied behavioral therapy for resident.
Facility staff does not award resident privacy during visit(s).
Facility staff denied POA access to resident’s medication log.
Residents are not provided access to telephone.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted a subsequent complaint visit to deliver final findings for the above allegations. The initial visit was conducted on 11/09/2022 by LPA De Leon who interviewed Administrator and collected pertinent documents. LPA Olson conducted a follow up visit on 11/30/22 with Tri-Counties Regional Center Quality Assurance Specialist (QAS) Miguel Magania. LPA and QAS conducted interviews with Staff and requested more documents. LPA and QAS also interviewed staff and witnesses on 12/15/22 and 12/22/22. During today’s visit, LPA Olson and QAS met with Administrator and explained the reason for the visit.

On the allegation: Facility staff did not provide medical attention for resident. It was alleged that Client 1 (C1) had a wound on their ankle that didn’t get proper medical attention. Client 1 moved into the facility on 7/8/22. Family Member 1 (FM1) provided pictures of the wound that were taken on 10/13/22, 11/05/22, and 11/25/22, and Family Member 2 (FM2) stated they visited C1 in September and observed the wound to be uncovered, have worse scabs and be open in certain places. Contined on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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 5

Control Number 29-AS-20221104164118

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: DOCTOR'S RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 425802130
	VISIT DATE: 02/22/2023

NARRATIVE

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FM2 stated the previous placement had nurses 24/7 and took good care of the wound and it looked like it was not being properly cared for at the current facility. LPA Olson reviewed Home Health notes that state facility took C1 to see PCP on 10/10/22 and ordered wound care twice a week. Doctors notes indicate that there is an ankle venous ulcer with “hemosiderin staining b/l ankles L lateral malleolus with overlying dried, nearly closed venous ulcer with significant amount of debris. # of visits: 15.” A nurse specialist came and did an evaluation on C1 on 10/19/21 and set up home health to come twice a week for wound care. Notes from C1’s Physical Exam on 4/6/22 state “nursing staff (NS)…reports that (C1) chronic venous stasis wounds have been healing quickly since the procedure” C1 had an iliac stenting in March. LPA reviewed C1’s Preplacement Appraisal Information (LIC 603) dated 7/5/22 that state under health C1 has a L ankle wound and under services needed Special medical attention stated “for wound care. Need primary care’s orders as well Talked to (FM who will)…be setting appointment with Primary in S Maria ASAP till then we’ll follow (FM) direction.”

LPA Reviewed Facility documents and see a physician visit communication forms: On 3/10/22 C1 had Outpatient Surgery Procedure LPA Reviewed surgery notes which state: “Pelvic Venogram w IVUS, Left Heel Wound Debridement, and Bilateral Common and External iliac vein angioplasty and stent placement. The diagnosis is “Chronic venous hypertension (idiopathic) with ulcer and inflammation of left lower extremity (CODE) (CMS/HCC)” “Indications for Surgery: …(C1) who over the past 5-6 years has had repeated recurrent wound on the left lateral ankle. Despite compression therapy, the wound seems to recur. A venous insufficiency ultrasound shows no evidence of axial reflux. I, therefore, was suspicious that there was a central venous compression or occlusion. We, therefore decided to perform a pelvic venogram, intravascular ultrasound and possible endovascular intervention."

On 8/13/22 C1 saw an urgent care physician. Reason for visit is Swelling on L ankle. Medication ordered or dose changed? Yes Medication name and changes: Antibiotic. New Diagnosis? No.
On 8/31/22 C1 had a Routine visit with their Neurologist. treatment/Instruction given is blank and medication ordered or dose changed said no. New diagnosis is no and were any medications discontinued? No. The doctor ordered Liver Hepatic Function panel and VALP Valproic acid blood work and scheduled a follow up appointment for 10/7/22 for EEG.

LPA and QAS interviewed Staff and Administrator who stated they followed FM directions on how to clean the wound because there were never any prescriptions or doctors’ orders until 10/10/22. Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 29-AS-20221104164118

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: DOCTOR'S RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 425802130
	VISIT DATE: 02/22/2023

NARRATIVE

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That was the soonest appointment FM1 could get. LPA reviewed doctors orders and MAR and saw no doctor’s orders for an ointment or directions on how to clean the wound. LPA tried to contact C1’s PCP multiple times but the PCP did not respond. LPA reviewed text messages between FM1 and Administrator. On 7/21/22 at 3:27 PM FM1 texted “Good afternoon I made a doctor’s appointment for (C1) at the CHC Clinics on N Blosser with (PCP) 1st available on Oct 10th @10:15am. The first available for (Previous PCP) is in January!” Based on the information obtained the allegation: Facility staff did not provide medical attention for resident is Unsubstantiated at this time.

On the allegation: Facility staff denied behavioral therapy for resident. It was alleged that the facility denied C1 from having behavioral therapy in the home. C1 sees a behavioralist for 2 hours 3 times a week. LPA and QAS interviewed C1’s service coordinator who stated they asked the Administrator to continue to have behavior sessions in the home but said that it was disruptive to another resident and maybe it could work if it was 30-60 minutes but not 2 hours. LPA interviewed Administrator who stated they never said sessions couldn’t take place in the home but only would prefer that they didn’t. LPA reviewed text messages between Administrator and FM1 and on 9/21/22 there was a text from Administrator that said, “We will connect on Friday for the next Behaviorist session as it did not go well with (C1) too stressful after that with very bad language towards staff and Client 2 (C2) had a rough evening till late and made afternoon staff pretty uncomfortable. We got to have a very calm and peaceful home as it’s been. Thanks for your understanding.” And a text from FM that said, “Behavior therapy can also happen at Momentum. In the meantime, I’ve contacted [Regional Center] to try to locate another placement. Everyone seems to be on leave or on vacation. But we’ll figure out what we can do until then to try to make everyone comfortable.” On 9/27/22 Administrator texted “Great thanks…also I do have staff for (C1) to go with you for the Therapy that much I be very happy to do or if I have time can join you guys for sometime Let me know what works for you and if it be comfortable for (C1) and the behavioralist.” On 10/20/22 text from FM states “I’m happy you and staff are interested in observing behavior therapy. Maybe once he’s in program? Or if you decide he can have therapy in the home when boys are in program? Whatever you decide.” LPA reviewed C1’s preplacement appraisal, which did not list the Behavioral Therapy would happen in the facility, but C1’s IPP dated 5/26/22 stated C1’s behavioral therapy would happen at their previous home. Administrator provided alternate solutions of Behavioral Therapy being held for a shorter duration or different location, due to it upsetting other clients in the home. Technical Assistance provided to ensure preappraisals are accurate and ask for IPP’s to be updated to ensure accuracy of care plans. Based on information obtained, the allegation: Facility staff denied behavioral therapy for resident is Unsubstantiated. Continued on 9099-C (pg 4)

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 29-AS-20221104164118

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: DOCTOR'S RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 425802130
	VISIT DATE: 02/22/2023

NARRATIVE

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On the allegation: Facility staff does not award resident privacy during visit(s). It was alleged that staff are always in the room and do not allow privacy for visits. LPA and QAS interviewed FM1 who stated there was a time that they wanted to shower C1 and get them ready but staff wouldn’t allow it and leave, they also stated that there was another time where staff stood there while they visited and a third time that staff was assisting with a broken VCR. FM1 then stated it wasn’t the privacy that was the main concern it was that they didn’t feel welcome and that they felt it was an issue and burden to visit. FM1 stated that Administrator ask to call at least 15 minutes in advance to visit so they could have C1 ready. Interview with Administrator revealed that they requested this as a convenience to ensure C1 was ready for their outings and so that staff and clients would be home when visitors wanted to come by. Interviews with staff revealed they might follow visitors in to inventory new clothes that came in or offer assistance to ensure visits went smoothly. All staff interviewed said they would allow visitors in and would never discourage or make a visitor feel unwanted. Many staff stated FM1 would come often and they would allow them to visit privately with C1. Based on the information obtained, the allegation, facility staff does not award resident privacy during visit(s) is Unsubstantiated at this time.

On the allegation: Facility staff denied POA access to resident’s medication log. It was reported that facility staff denied POA access to resident’s medication log. LPA and QAS interviewed FM1 who stated they requested the facility give them access to C1’s medication log and staff said they would have to check. FM1 stated it took the facility 2 days then said it took them 5 days until they could pick it up. LPA and QAS interviewed C1’s case manager who requested a copy via email and stated they received it the next day. Administrator stated they provided FM1 the documentation the same day after it was requested. Based on the information obtained the allegation: Facility staff denied POA access to resident’s medication log is Unsubstantiated at this time.

On the allegation: Residents are not provided access to telephone. It was alleged that the facility did not give family members access to the facilities home number. LPA and QAS interviewed FM1 who stated they could never reach anyone at the home and the voicemail was always full. LPA and QAS interviewed FM 2 who stated that they were only given the Administrator’s cell and they would try to leave voice messages but the voicemail was always full and it was hard to get a call back. FM 2 stated that they would have come to visit more often if it was easier to get a hold of staff and check if it was a good day for a visit or not. LPA and QAS interviewed staff who stated they always try to answer the phone. Some staff said if they miss a call they will call back and others said if it’s important the caller will call back and then answer it. Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 29-AS-20221104164118

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: DOCTOR'S RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 425802130
	VISIT DATE: 02/22/2023

NARRATIVE

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LPA attempted to call the facility and found that the line was busy and couldn’t leave a message but the staff called back shortly after to see how they could help. LPA reviewed text between FM1 and Administrator and saw a text on 9/14/22 around 2:11 PM from FM1 “Is there a house phone?” and from Administrator, “Yes there is but they sometimes don’t pick up if they are busy with clients or on an outing. Best to call or text me so that we can connect in 5-10 minutes. (Home number)”, Based on the information obtained the allegation: Residents are not provided access to telephone is Unsubstantiated at this time.

Exit interview conducted, copy of report emailed and printed.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

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