445294156-4-15-2022-26-AS-KHOS-CDWNMS-20220428103538

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445294156
Report Date: 04/15/2022
Date Signed: 04/15/2022 06:03:17 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, 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
06/23/2020 and conducted by Evaluator Ryker Heberle

COMPLAINT CONTROL NUMBER: 26-AS-20200623153627

FACILITY NAME:	BROOKDALE SCOTTS VALLEY		FACILITY NUMBER:	445294156
ADMINISTRATOR:	HARRISON, PAUL		FACILITY TYPE:	740
ADDRESS:	100 LOCKEWOOD LN		TELEPHONE:	(831) 438-7533
CITY:	SCOTTS VALLEY	STATE: CA	ZIP CODE:	95066
CAPACITY:	220	CENSUS: 141	DATE:	04/15/2022
		UNANNOUNCED	TIME BEGAN:	03:01 PM
MET WITH:	Christine Montelaro		TIME COMPLETED:	06:02 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff failed to give resident medication as prescribed

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Ryker Heberle an unnancounce complaint inspection to deliver the findings to the above allegation. LPA spoke with Robert Alverado, Interim Executive Directior and Business Office Manager (BOM) .

Between 7/1/2020 and 9/9/2020, nine staff members were interviewed. 7 out of 9 confirmed that antibiotics are started right away or within the same day. 7 out of 9 confirmed that delays are usually caused by a doctor’s orders not being attached to the medication. 8 out of 9 confirmed that medications are usually picked up from the front desk on the same day. Based on interviews, however, there are several factors that can cause a delay, but new medications are usually started within 24 hours as a best practice.

Continued on Page 2

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: 04/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022

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 2

Control Number 26-AS-20200623153627

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: BROOKDALE SCOTTS VALLEY	FACILITY NUMBER: 445294156
	VISIT DATE: 04/15/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Between 9/10/2020 and 9/11/2020, six residents were interviewed. 5 out of 6 stated that they are receiving their medications on time and are given their medications as prescribed. 1 out of 6 stated that she does not take medications.

The Medication Administration Record (MAR) for June 2020 was reviewed for 9 residents. 8 out of 9 residents received their medications on time as indicated on the MAR. 1 out of 9 residents was given the medication later than what was input into the MAR but was still given the medication the same day.

The Medication Delivery Log was also reviewed for June 2020. 1 resident did not receive the new medications on the same day. The new medications were picked up before 2 pm the same day but was not inputted into the MAR and given to the resident until the next day, causing a 24-hour delay in the resident receiving antibiotics in a timely manner. However, 1 staff confirmed that it is not a requirement that antibiotics be started right away, but it is taught during training as a best practice.

The faculty’s medication management policies were reviewed and there was nothing noted on when the medications will be administered upon receipt/delivery.

Title 22 does not address the timeframe of when new medications needs to start or be given; however, the facility must follow the doctor’s order. The review of the doctor’s order for the medication mentioned above did not note that the medication needs to be started immediately.

This Department has investigated the above allegation. Based on interviews and record reviews, 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 Robert Alverado, Interim Executive Director, and a copy of this report was provided. Report was signed by Business Operation Manager, Christine Montelaro with approval of and on behalf of Robert Alverado, Interim Executive Director.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker Heberle	TELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2