565801979-2-28-2023-29-AS-DPEA-CQ4TYL-20230320150855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801979
Report Date: 02/28/2023
Date Signed: 02/28/2023 12:20:43 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, 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
07/14/2022 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20220714103718

FACILITY NAME:	WELLNESS CARE SENIOR LIVING		FACILITY NUMBER:	565801979
ADMINISTRATOR:	MARIA HERNANDEZ		FACILITY TYPE:	740
ADDRESS:	158 ROCKAWAY ROAD		TELEPHONE:	(805) 649-5143
CITY:	OAK VIEW	STATE: CA	ZIP CODE:	93022
CAPACITY:	56	CENSUS: 26	DATE:	02/28/2023
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Maria Hernandez		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Resident was physically assaulted by another resident while in care.
Staff did not ensure resident's call button was accessible.
Resident was left on the ground for an extended period of time.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial visit was conducted on 07/18/2022 by LPA M. Arroyo. On today’s visit, LPA Arroyo met with the Administrator, Maria Hernandez. Entrance interview conducted.

During the initial visit on 07/18/2022, LPA Arroyo conducted a tour of the facility and observed random resident bedrooms at 10:43 a.m., conducted interviews with the administrator, three staff, and six residents between 10:50 a.m. 11:35 a.m., and began record review of resident files and obtained copies of resident records and other pertinent documents at 11:45 a.m. LPA also conducted a collateral visit to another licensed facility to interview Resident #1 (R1) at 2:38 p.m. On 08/05/2022, LPA conducted telephonic interviews with three family members at 11:46 a.m., 12:07 p.m., and 2:16 p.m.

Report Continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

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 29-AS-20220714103718

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: WELLNESS CARE SENIOR LIVING	FACILITY NUMBER: 565801979
	VISIT DATE: 02/28/2023

NARRATIVE

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Report Continued from LIC 9099...

It was alleged that resident was physically assaulted by another resident while in care. It was reported that a resident attacked another resident and a few weeks later, the same resident was seen attacking a different resident and there was no staff around supervising. Interviews conducted with the Administrator revealed the facility has cameras throughout the common areas. The Administrator stated there has not been any residents that become aggressive towards other residents other than one resident that has been sundowning late in the afternoon towards the evening. Staff stated residents are calm and tend to hangout and keep to themselves. Interviews with residents conducted revealed residents behave and are nice amongst each other. Interviews with family members conducted revealed they have not observed any altercations while visiting the facility. Additionally, family members stated staff are always around and have observed both staff and residents being calm. Furthermore, family members reported having no concerns with the facility and staff as they feel they are looking after the residents and keeping them safe. Based on interviews conducted with the administrator, staff, residents, and family members, there is insufficient evidence to support the allegation of “resident was physically assaulted by another resident while in care.” Therefore, this allegation in deemed Unsubstantiated at this time.

It was also alleged that staff did not ensure resident’s call button was accessible. It was reported that R1 did not have reasonable access to the call button that was across the room from their bed. The staff placed a string on the call button, but R1 would have to be in a certain position to access it. During the facility tour on 07/18/2022, the LPA observed random resident bedrooms and the following was observed. Resident bedrooms have the call button on either the side of the wall or by the entrance next to the light switch. Interviews conducted with the Administrator revealed the call button placement has been the same since the facility opened in 2014. In order for the residents to be able to use the call button when needed, the facility attached a long string to the call button that is accessible to the residents from their bed. Additionally, the Administrator reported that while conducting facility and rooms tours, the staff makes sure to communicate with the families and potential residents of the location of the call buttons. The facility has three (3) call boxes that blink the room number if a call button was pushed. There are two (2) call boxes in the dining room and one (1) call box in the patio area. Furthermore, the LPA was able to see the call boxes light up when a call button was pushed.

Report Continued on LIC 9099C...

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220714103718

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: WELLNESS CARE SENIOR LIVING	FACILITY NUMBER: 565801979
	VISIT DATE: 02/28/2023

NARRATIVE

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Report Continued from LIC 9099...

Interviews conducted with family members revealed that they are aware of the placement of the call buttons inside the resident’s bedroom. However, the families displayed no concern because they feel the staff is regularly monitoring and caring for the residents throughout the day. Based on all information gathered during the course of the investigation, there is insufficient evidence to support the allegation, “staff did not ensure resident’s call button was accessible”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was further alleged that resident was left on the ground for an extended period of time. It was reported that R1 had called stating they were on the floor for several hours and staff was not checking up on them. Interviews with the Administrator revealed the facility has a list of residents that require routine check-ups throughout the day and night due to being a high fall risk. Additionally, it was reported that staff check on the residents at least every couple of hours while alone in their rooms or out of their direct view. Interviews with family member revealed that resident’s family members often go to the facility to visit. Family members stated the facility was good at communicating and notifying them of any incidents at the facility. Additionally, family members reported that residents have been doing better since moving into the facility. Furthermore, family members stated they had no concern with the facility as they feel the staff looks after the residents and keep them safe. Based on the information obtained and reviewed, there is insufficient evidence to support the allegation, “resident was left on the ground for an extended period of time”. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. Report was reviewed and a copy was issued to the Administrator.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

LIC9099 (FAS) - (06/04)

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