425850365-7-11-2024-29-AS-KBUY-D7NQHF-20240730121104

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850365
Report Date: 07/11/2024
Date Signed: 07/11/2024 12:48:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
06/27/2024 and conducted by Evaluator Brian Phillips

COMPLAINT CONTROL NUMBER: 29-AS-20240627081510

FACILITY NAME:	FOUNTAIN SQUARE OF LOMPOC		FACILITY NUMBER:	425850365
ADMINISTRATOR:	MURRAY, ROBIN		FACILITY TYPE:	740
ADDRESS:	1420 W NORTH AVENUE		TELEPHONE:	(805) 736-1234
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	130	CENSUS: 68	DATE:	07/11/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Sarah Kau, Community Relations Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility staff did not meet residents' needs

INVESTIGATION FINDINGS:

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On 07/11/2024, Licensing Program Analyst (LPA) Brian Phillips conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA Phillips met with Community Relations Director Sarah Kau as the Executive Director/Administrator of the facility was unavailable at the time, and explained the reason for the visit.

On the allegation: Facility staff did not meet residents' needs. It is alleged that during a hospital visit, Resident #1 (R1) was observed to have feces on their backside, under their untrimmed nails, and on their arms. The allegation stated that neglect on the part of the facility staff was not believed to be happening purposefully, but rather due to the level of care needed by R1 and R1’s current living situation within the facility.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

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-20240627081510

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FOUNTAIN SQUARE OF LOMPOC	FACILITY NUMBER: 425850365
	VISIT DATE: 07/11/2024

NARRATIVE

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On 07/03/2024, Licensing Program Analyst (LPA) conducted a complaint investigation visit to the facility above. R1 was assessed by the facility in the preplacement appraisal on 02/26/2024 as in the process of beginning cancer treatment for Glioblastoma. In March 2024, R1 began concurrent treatment with chemotherapy radiation as well as oral medication for the cancer Gliobastoma multiforme/tumor. R1 and the facility were also informed that R1 needed to take the oral medications for the cancerous tumor on an empty stomach and that these medications had serious side effects. Physician notes for R1 from the oncology department of the hospital as well as R1’s primary care physician indicate on 05/03/2024 that R1 needed to modify and/or decrease certain oral chemotherapy medications due to having serious side effects which were warned about previously by the prescribing physician. LPA reviewed physician communications with the facility on 06/02/2024, R1 had been found lying in bed having a seizure and 911 was called. R1 was taken to the hospital and returned the next day with a diagnosis of a non-epileptic seizure caused by certain medicines taken by R1 for cancer or R1’s cancerous brain tumor. On 06/08/2024, R1 had continuous diarrhea which was very runny and had a horrible smell which was attributed to the side effect of the oral medications for cancer. On 06/11/2024, R1 was again taken to the hospital for a non-epileptic seizure in the facility which was attributed to a reaction from oral chemotherapy medications and/or R1’s cancerous brain tumor. Narrative Charting from the facility stated that on 06/12/2024 R1 was found unresponsive and with no pulse at night in the facility. CPR was started immediately and 911 was called. R1 was taken to the hospital and admitted into the Critical Care Unit (CCU). The family of R1 was notified and R1 passed away the next day on 6/13/2024. Staff interviewed by LPA stated that when R1 passed away, a physician was waiting for brain scan results to complete a pending Hospice Care admission. Through record review, LPA learned that on 05/31/2024 R1 was evaluated by Home Health Agency for Hospice Admission, but this process was pending at the time of R1’s death due a physician ordered MRI on R1’s brain being needed to complete the hospice admission process. Through interview with Staff and record review, LPA learned that severe diarrhea was one of the side effects of the oral medications R1 was taking for cancer treatment. LPA interviews with Staff also revealed that R1 was being seen weekly for radiation oncology at the time of death and had multiple seizures attributed to either a reaction to the oral chemotherapy medications or due to the brain tumor in R1. The non-epileptic seizures also caused R1 to have loss of bladder and bowel control.

Through record review of Staff roster/schedule and interview, LPA was informed that the facility has been in the process of a staffing hire for multiple positions in June and July of 2024.
Continued on 9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240627081510

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FOUNTAIN SQUARE OF LOMPOC	FACILITY NUMBER: 425850365
	VISIT DATE: 07/11/2024

NARRATIVE

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The facility is aware of the disadvantages of being potentially understaffed and have been actively trying to correct this through hiring multiple new employees. No resident interviewed by LPA in either the Assisted Living or Memory Care portion of the facility indicated that any of their Activity of Daily Living (ADL) needs are not being met by facility staff. Through Staff interview, LPA was told that R1 would have severe diarrhea and continuous runny bowel movements sporadically among other serious side effects as a result of the oral chemotherapy medication and that Staff monitored R1 to assist with hygiene, but the diarrhea could happen very suddenly and may have occurred while R1 was being transported to the hospital or while in the hospital which could not have been cleaned or assisted to by facility staff. Physician Reports for R1 on 06/02/2024 and 06/11/2024 stated that a symptom of R1’s non-epileptic seizures due to the cancerous tumor was loss of bladder and bowel control. As R1 was hospitalized on 06/11/2024 due to a non-epileptic seizure in the facility, a symptom of this would be loss of bowel control while being transported to the hospital or while in the hospital after 911 was called by the facility and paramedics arrived.

Based on the information obtained, there was insufficient evidence that facility staff did not meet residents’ needs. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. Copy of this report provided to the facility.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

LIC9099 (FAS) - (06/04)

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