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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850004
Report Date: 12/06/2022
Date Signed: 12/06/2022 06:49:34 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
06/03/2022 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20220603150229
FACILITY NAME:YOKAM'S RCFE #1FACILITY NUMBER:
425850004
ADMINISTRATOR:KAMTO, YOLANDE KONGUEP T.FACILITY TYPE:
740
ADDRESS:958 E TUNNELL STTELEPHONE:
(805) 922-7670
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:0CENSUS: 0DATE:
12/06/2022
UNANNOUNCEDTIME BEGAN:
06:15 PM
MET WITH:Alphonse Kamato, LicenseeTIME COMPLETED:
06:50 PM
ALLEGATION(S):
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Staff are not turning the resident every 2 hours
Due to staff neglect, resident sustained a pressure injury while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson delivered findings for the above allegations via telephone due to the facility being closed. LPA met with Alphonse Kamato, Licensee and explained the reason for the visit/call.

On 06/03/2022, the Department received a complaint alleging that in September 2021, the facility staff were not turning Resident #1 (R1) every 2 hours and due to staff neglect, R1 sustained a pressure injury while in care.
On 06/09/2022, from 11:00am to 2:30pm, Licensing Program Analyst (LPA) Olson conducted the initial 10-day complaint visit. The facility closed due to a change of ownership effective 01/12/2022. LPA Olson met with the new Licensee/Administrator Aprilyn Soriano and explained the purpose of the visit. The LPA spoke with the previous Licenseeand Administrator over the phone and explained the Department received a complaint against the closed facility. The LPA toured the facility, conducted interviews with staff and the previous Licensee and Administrator, and requested documents pertinent to the investigation. Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022
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-20220603150229
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: YOKAM'S RCFE #1
FACILITY NUMBER: 425850004
VISIT DATE: 12/06/2022
NARRATIVE
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According to the physician’s report dated 01/27/2021, R1 had the following diagnoses and health conditions including CHF, Aortic Stenosis, Paroxysmal Atrial Fibrillation, blindness, functional quadriplegia, had a history of skin breakdown (buttock decubiti), non-ambulatory and physical health status was listed as poor. The report also documented R1 had no capacity for self-care which indicates R1 depended on others for all activities of daily living. This is considered a prohibited health condition and will be cited on a separate report.

Records reviewed indicated R1 was admitted to the facility on 12/15/2020. Upon admission it was noted that R1 had a bed sore (pressure injury) to buttock. Facility progress notes reviewed for the time period of December 2020 through December 2021 indicate Home Health treated R1 for ongoing stage 1 and 2 pressure injuries to coccyx, buttock, and heel. The progress notes also indicate that staff were repositioning R1 frequently, as needed, and documented observations in R1’s skin condition. Dignity Home Health notes revealed the nurse performed wound care to R1’s pressure injuries and instructed staff during visits regarding pressure relieving measures.

On the allegation “Staff are not turning the resident every 2 hours” Based on the information obtained through staff interviews and facility progress notes, staff indicated they were repositioning the resident every 2 hours as per the direction of the Dignity Home Health nurses. Home Health notes reviewed indicated R1 was in a different position every time the nurse visited. Based on the information obtained, the allegation “Staff are not turning the resident every 2 hours” is deemed Unsubstantiated at this time.

On the allegation “Due to staff neglect, resident sustained a pressure injury while in care” –R1 had a history of skin breakdown/pressure injuries that were being treated by home health during R1’s stay at the facility. Staff indicated they were repositioning R1 every 2 hours as directed by the home health nurse. There was no indication or concern by the home health nurse that the staff were not following the repositioning directions. Due to the health conditions of R1, the care of R1’s pressure injuries was ongoing since the time of R1’s admission to the facility. Based on the information obtained, the allegation “Due to staff neglect, resident sustained a pressure injury while in care” is deemed Unsubstantiated at this time.

Exit interview conducted and a copy of this report issued via email and mail.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022
LIC9099 (FAS) - (06/04)
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