435202820-5-4-2023-26-AS-KHOS-CSHHUQ-20230605063043

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202820
Report Date: 05/04/2023
Date Signed: 05/04/2023 04:29:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/02/2023 and conducted by Evaluator Ryker Heberle

COMPLAINT CONTROL NUMBER: 26-AS-20230502090743

FACILITY NAME:	WHITE OAKS SENIOR LIVING		FACILITY NUMBER:	435202820
ADMINISTRATOR:	LADWIG, IRISH		FACILITY TYPE:	740
ADDRESS:	1680 WHITE OAKS RD.		TELEPHONE:	(408) 821-2630
CITY:	CAMPBELL	STATE: CA	ZIP CODE:	95008
CAPACITY:	6	CENSUS: 6	DATE:	05/04/2023
		UNANNOUNCED	TIME BEGAN:	01:01 PM
MET WITH:	Irish Ladwig		TIME COMPLETED:	04:34 PM

ALLEGATION(S):

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Facility staff did not take proper measures to prevent the spread of scabies at facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst Ryker Heberle (LPA) visited the facility to conduct an unannounced complaint investigation. LPA met with facility administrator Irish Ladwig (Admin).

During the course of the investigation, LPA interviewed 3 residents and 3 witnesses. 3 out of 3 residents stated that they have not experienced itching or rashes in recent memory. LPA did not observe rashes on any residents. 1 out of 3 witnesses stated that their relative at the facility had rashes on her abdomen, but stated that it was not scabies.

In review of resident files, it was determined that 1 out of 5 residents currently living at the facility had scabies. LPA reviewed the file of resident with scabies (R1).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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 26-AS-20230502090743

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: WHITE OAKS SENIOR LIVING	FACILITY NUMBER: 435202820
	VISIT DATE: 05/04/2023

NARRATIVE

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In review of R1's physician report, it was determined that R1 has a history of skin conditions. in interview with R1's responsible parties (W1 & W2), W1 & W2 indicated that R1's skin condition has lasted for over 10 years, and had determined that it was likely due to allergies. R1's needs and services plan indicated that the facility assessed R1 for signs of skin breakdown daily. Review of R1's doctor's orders indicated that R1 visited the hospital for a check in on 03/10/2023. Doctor's order from 03/15/2023 indicates that a dermatologist reviewed photos of R1's rash, and diagnoses R1's skin condition as dermatitis, with differential diagnoses of drug reaction or scabies. Doctor's order does not call for scraping to determine scabies condition. Doctor's order indicated that the facility should continue using topical steroid, use anti-itch cream, keep skin moisturized, and return for evaluation if condition remains unimproved after 1 month. File review and interviews conducted determined that the facility was adhering to 03/15/2023 doctor's order appropriately.

R1 was taken to the hospital due to fainting on 04/05/2023. R1 was at the hospital for 3 days before being transferred to a second hospital. Upon transfer to the second hospital, R1 was diagnosed with scabies. W1, W2, and facility staff stated that R1 exhibited no signs of worsening skin condition between the dates of 03/10/2023 and 04/05/2023. W1 & W2 stated that while R1 was at the first hospital, there was no indication from the hospital staff that R1 had scabies, and R1 was not placed under quarantine. As of the writing of this report, no other staff or residents have been diagnosed with scabies.

This Department has investigated the above allegation. Based on observation, interviews and records review, the Department has determined that the allegation is UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

This report was reviewed with Administrator Irish Ladwig and a signed copy of the report was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC9099 (FAS) - (06/04)

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