500306146-6-1-2023-27-AS-KHOS-CSXP7N-20230619110414

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 500306146
Report Date: 06/01/2023
Date Signed: 06/01/2023 02:28:14 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/21/2023 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20230221154210

FACILITY NAME:	LAS PALMAS ESTATES		FACILITY NUMBER:	500306146
ADMINISTRATOR:	MILLER, KREGG		FACILITY TYPE:	740
ADDRESS:	1617 COLORADO		TELEPHONE:	(209) 632-8841
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95382
CAPACITY:	89	CENSUS: 84	DATE:	06/01/2023
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Le Ann Blocker Resident Coordinato		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility staff did not ensure that resident received care for their prosthetic leg in a timely manner

Facility has pests

Facility staff are not providing resident with a new bed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Le Ann Blocker Resident Coordinator and explained the reason for the visit.

Facility staff did not ensure that resident received care for their prosthetic leg in a timely manner- Based on interviews with staff, witness and Resident (R1). Facility records LIC602 for R1 dated 7/7/2022 indicates that R1 is able to bath self with marginal self-care. R1 wears a prosthesis and get's help with staff to make sure get proper care and supervision that R1 needs while at the facility. R1 has Turning Point services to help with doctor appointments and care for R1 prosthesis. The facility does not have the authority to order a prosthetics for R1.

Based facility records review, interviews with staff, witness and R1 on the information provided, it was unclear if facility staff did not ensure that resident received care for their prosthetic leg in a timely manner, therefore the allegation was deemed UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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 27-AS-20230221154210

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: LAS PALMAS ESTATES	FACILITY NUMBER: 500306146
	VISIT DATE: 06/01/2023

NARRATIVE

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Based on facility records review, interviews with staff, witness and R1 on the information provided, it was unclear if facility staff did not ensure that resident received care for their prosthetic leg in a timely manner, therefore the allegation was deemed UNSUBSTANTIATED.

Facility has pests- LPA Lund reviewed facility records, observation, interviewed staff, Resident (R1) and residents in care. LPA Lund reviewed the Clark Pest Control facility service history from 4/20/2023 through 6/1/2023 stating the facility has pest control service at the facility weekly. The facility has weekly pest control done at the facility . LPA Lund observed R1 who had no signs of pests’ bites.

Based on facility records review, observation, interviews with staff, witness and R1 on the information provided, it was unclear if Facility has pests, therefore the allegation was deemed UNSUBSTANTIATED.

Facility staff are not providing resident with a new bed- Based on observation and interviews with staff, witness and resident (R1). R1 has never complained to staff are R1’s Turning Point service coordinator regarding R1’s bed. R1 stated that “The bed was confrontable.” The bed does have a plastic liner over the mattress and LPA didn’t observe any pests on the bed.
Based on facility records review, observation, interviews with staff, witness and R1 on the information provided, it was unclear if Facility has pests, therefore the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted with Le Ann Blocker Resident Coordinator and a copy of report was left.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC9099 (FAS) - (06/04)

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