425850082-6-6-2023-29-AS-KBUY-CSQT95-20230612143121

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850082
Report Date: 06/06/2023
Date Signed: 06/06/2023 02:57:36 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
08/15/2022 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20220815140236

FACILITY NAME:	MOUNTAIN RIDGE HOME CORP		FACILITY NUMBER:	425850082
ADMINISTRATOR:	BAKER, CINDY		FACILITY TYPE:	734
ADDRESS:	3271 OLD HIGHWAY 246		TELEPHONE:	(650) 267-9482
CITY:	SANTA YNEZ	STATE: CA	ZIP CODE:	93460
CAPACITY:	5	CENSUS: 5	DATE:	06/06/2023
		UNANNOUNCED	TIME BEGAN:	12:18 PM
MET WITH:	Cindy Baker, Administrator		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Facility staff mismanaged resident's medication

INVESTIGATION FINDINGS:

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On 6/06/23 at 12:18 pm, Licensing Program Analyst (LPA) Chavez conducted an unannounced visit to follow-up on a complaint dated 8/15/22. LPA met with Cindy Baker, Administrator, and explained the reason for the visit.

On the allegation, “Facility staff mismanaged resident’s medication,” the complainant was concerned that staff were not giving residents’ their medications and staff were taking narcotics from the facility. To investigate, LPA interviewed the administrator, staff, and witnesses, and reviewed records.

Between 5/18/23 and 5/25/23, LPA interviewed witnesses. Witnesses say they looked into the allegation and did not find anything concerning nor any issues with medication management. Witnesses also say management proactively retrained staff on medication management shortly after the allegation was made.

Continued on 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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-20220815140236

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: MOUNTAIN RIDGE HOME CORP	FACILITY NUMBER: 425850082
	VISIT DATE: 06/06/2023

NARRATIVE

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On 5/23/23 at 2:05 pm, LPA interviewed Donna Pieprzycki, RN/Nurse Consultant. RN states that she is not aware of any staff who have not given medications as directed, except one instance in September 2022. She says the staff got busy and made an error. She says the client’s physician was contacted and there were no adverse effects to the client. She says she has not seen or heard of any narcotics missing from the facility and states that clients who take narcotics would have extreme behaviors if not given these medications. She notes that these clients have not exhibited extreme behaviors.

On 6/6/23 at 12:39 pm, LPA interviewed Cindy Baker, Administrator. Administrator states that there are five (5) clients who take narcotics. She says if clients are screaming constantly, they are in pain, and staff would know if clients need their medications. She confirms staff had a medication error in September 2022, the client’s physician was contacted, and there were no issues with the client’s health due to the error.

On 6/6/23 between 1:05 pm and 1:25 pm, LPA interviewed staff. Staff say they have not witnessed nor heard of any staff making medication errors and have not found medications missing. Staff also say clients taking narcotics would have agitation and outbursts, if they missed their medications, and staff say they have not observed this.

On 6/6/23, LPA reviewed medications, Centrally Stored Medication List and MARS for Client #1 (C1). No issues were found.

Based on the evidence obtained, the allegation “Facility staff mismanaged resident's medication,” is deemed Unsubstantiated at this time.

Exit interview conducted, report given to the administrator.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC9099 (FAS) - (06/04)

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