486801578-6-30-2020-21-AS-BMOS-BR3R95-20200630124856

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486801578
Report Date: 06/26/2020
Date Signed: 06/30/2020 08:53:05 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/03/2020 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20200103173048

FACILITY NAME:	WOODRIDGE RESIDENTIAL CARE II		FACILITY NUMBER:	486801578
ADMINISTRATOR:	CARTEL, JULLY		FACILITY TYPE:	740
ADDRESS:	738 OAKWOOD AVE.		TELEPHONE:	(707) 557-5939
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	6	CENSUS: 5	DATE:	06/26/2020
		UNANNOUNCED	TIME BEGAN:	04:15 PM
MET WITH:	Jully Cartel		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Resident retained with a prohibited condition.
Staff isolates resident.
Staff are not trained.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) A. Canela contacted Jully Cartel, Administrator at Woodridge Residential Care II Facility by telephone on 6/26/2020 for the purpose of delivering findings on a complaint investigation 21-AS-20200103173048. Due to COVID – 19 precautions a facility visit is not able to be conducted at this time.

The Department conducted a complaint investigation regarding the allegations listed above for . LPA Canela also received statements and gathered records. On 12/28/2019, resident R1 was hospitalized as result of a pressure injury to his buttocks. Medical records revealed R1 had sepsis without acute organ dysfunction, pressure ulcer of sacrum, and buttocks abscess(associted with the sacral ulcer). R1 had surgery for sacral decubitus ulcer. R1 had been diagnosed with multiple medical problems, specifically diabetes mellitus type II with chronic skin ulcers. As such the wound on his buttocks did not visually present immediate concern to the facility. Staff interviewed by the department cooborated that the wound on his buttocks was small and they were treating it with antibiotic ointment.

Continue report see LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2020

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 21-AS-20200103173048

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: WOODRIDGE RESIDENTIAL CARE II	FACILITY NUMBER: 486801578
	VISIT DATE: 06/26/2020

NARRATIVE

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Furthermore, records show R1 was seen by medical physicians two times in the month of December, 2019 all prior to R1's hospitalization in which R1's health status was updated with no indication of pressure injury. Interviews of facility staff were consistent with the most part. However, staff could not conclusively say when they noticed the wound to R1's buttocks.

It was also alleged staff isolates resident and staff are not trained.
LPA A. Canela conducted interviews and reviewed information. LPA did not receive any statements corroborating R1 was isolated, furthermore LPA observed resident R1 spending time in the living room and all residents have access to areas used for care by the facility; residents are also able to access the patio yard. LPA reviewed required annual training for staff and records indicate the training staff have received.

The Department has investigated the above allegations and determined, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations for Resident retained with a prohibited condition; staff isolates resident and staff are not trained are all Unsubstantiated.

This report was emailed to facility to obtain signature.
During investigation, LPA found areas of none compliance by the facility that will need to be addressed in a separate report.

No citations issued.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2020

LIC9099 (FAS) - (06/04)

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