565801979-4-11-2023-29-AS-JAPL-CRC3LG-20230428182042

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801979
Report Date: 04/11/2023
Date Signed: 04/11/2023 04:48:05 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
12/15/2021 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 29-AS-20211215102348

FACILITY NAME:	WELLNESS CARE SENIOR LIVING		FACILITY NUMBER:	565801979
ADMINISTRATOR:	ALEIDA ALONSO		FACILITY TYPE:	740
ADDRESS:	158 ROCKAWAY ROAD		TELEPHONE:	(805) 649-5143
CITY:	OAK VIEW	STATE: CA	ZIP CODE:	93022
CAPACITY:	56	CENSUS: 25	DATE:	04/11/2023
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Maria Hernandez		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Staff do not answer the facility telephone
Staff do not address the multiple tripping hazards on the facility grounds
Resident sustained scabies while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to the above facility. LPA met with Administrator Maria Hernandez at 9:40 a.m. Entrance interview conducted.

On 12/15/2021, the Department received a complaint alleging that staff do not answer the facility telephone, staff do not address the multiple tripping hazards on the facility grounds and resident sustained scabies while in care. On 12/22/2021, starting at 11:33 a.m., LPA Ascencio and LPA JoAnn Rosales called the facility telephone number and spoke with a staff member who stated that the telephone does not work well on rainy days. Later that day, the LPA’s conducted Staff #1 (S1) interview at 2:13 p.m. Interview with S1 revealed that the facility has two (2) working telephones; one (1) is in the Administrator office and the other is located in the medication room. Additionally, S1 added that the normal business times for telephone service is from 8:00 a.m. – 5:00 p.m. If a family wished to talk to a resident, the family member will call or text the Administrator, the Administrator will contact a staff member at the facility who will have the resident call the family member.
Continued on LIC 9099 - C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

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 5

Control Number 29-AS-20211215102348

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: 04/11/2023

NARRATIVE

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S1 added that the phone lines have voicemail capabilities and will return any calls as soon as possible. During the visit, the LPA’s observed the telephone ringing and being answered promptly by S1 on numerous occasions. On 04/10/2023, LPA Ascencio attempted 2 telephone calls at 5:15 p.m. and 5:35 p.m. Staff did not answer phone calls. On 04/11/2023, starting at 9:20 a.m., LPA called and spoke to a staff member. Later that same day, LPA conducted an interview with Administrator Maria Hernandez, at 9:40 a.m. Interview with Administrator Hernandez confirmed what S1 stated. Additionally, Administrator Hernandez added that 6:00 p.m. is the cut off time for telephone services but they are available by cellphone to help after hours. Throughout that same day, LPA Ascencio observed various telephone call being received and answered promptly by Administrator Hernandez and staff.

LPA Ascencio spoke with Administrator Hernandez regarding resident rights regarding accepting and receiving telephone calls and having a staff member in charge of telephone service after hours. Administrator Hernandez stated they will switch out their telephone system to a wireless phone so that staff can carry and answer phone calls after hours.

Although there was 1 instance that facility staff did not answer the LPA’s phone call, during 2 facility visits and additional LPA phone calls, staff was observed to respond to telephone calls. Thus, based on observation, the allegation is deemed unsubstantiated at this time.

Regarding staff do not address the multiple tripping hazard on the facility grounds. During a facility tour with S1 at 11:50 a.m., on 12/22/2021, LPA Ascencio and LPA Rosales observed various elevated concrete areas around the base of a tree. These areas were observed to have additional cement to level out the walkway. S1 stated that the roots of the tree have been coming in and making the walkway uneven. S1 added that early December 2021, they cut the visible roots and added cement to the walkway as it was causing resident to trip. LPA Ascencio and Rosales advised S1 to even out the additional cement as it was coming apart due to weather and usage. On 09/26/2022, starting at 10:30 a.m. and on 04/11/2023, starting at 9:52 a.m., LPA Ascencio conducted a facility tour and did not observe any tripping hazards on facility grounds. Additionally, the previously cemented areas were observed to be flush, appeared to be leveled and properly maintained. Thus, based on observation, the allegation is deemed unsubstantiated at this time.

Continued on LIC 9099 - C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 29-AS-20211215102348

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: 04/11/2023

NARRATIVE

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Lastly, regarding the allegation of resident sustained scabies while in care. During a facility visit on 12/22/2021, LPA Ascencio and Rosales conducted S1 interview starting at 2:13 p.m. Interview with S1 revealed that Resident #1 (R1) was sent to the hospital in the middle of October 2021 due to being unresponsive during a checkup. R1 returned on November 17^th, 2021, after being diagnosed and treated for scabies. S1 stated that R1 acquired scabies at the hospital and returned with medication. S1 added that same day, S1 and Administrator Aleida Alonso communicated, via email, with a Ventura County Public Health Communicable Disease Program nurse (VCPH) regarding the scabies resident. S1 added that based on VCPH recommendation, anyone that was in contact with R1 should be treated as a precaution. A total of thirty-five (35) resident were treated as precautionary measures with R1 being the only diagnosed resident with scabies. Additionally, S1 added that an incident report was submitted to Community Care Licensing (CCL) on 11/24/2021. Interview with Administrator Maria Hernandez on 04/11/2023, starting at 9:40 a.m., confirmed what S1 stated. LPA Ascencio obtained a copy of a scabies line list that confirms 35 residents being treated and 1 positive, an email copy sent to VCPH about R1 having scabies, a copy of hospital discharged documentation confirming R1’s scabies diagnosis and a copy of the incident report that was submitted to CCL. Interview with VCPH representative on 04/11/2023, starting at 10:45 a.m. revealed that the facility had 1 positive scabies case in November 2021 that was reported. Additionally, VCPH representative stated that three (3) or more cases of any infectious disease is considered an outbreak. With this case, there was only 1 resident that was confirmed to have scabies. We recommended the Administrator to provide treatment to all resident who were in close contact with R1. No additional cases were reported.

A review of Title 22, California code of regulations, section 87211 Reporting Requirements (a)(1)(D) states: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident.” A review of section 87211 Reporting Requirements (a)(2) states: Occurrences, such as epidemic outbreaks, poisonings, catastrophes, or major accidents which threaten the welfare, safety or health of residents, personnel, or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate.” Continued on LIC 9099 - C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 29-AS-20211215102348

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: 04/11/2023

NARRATIVE

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Although the R1 was admitted to the hospital in November 2021, it is not clear whether R1 sustained scabies at the facility or the hospital. Upon R1’s return to the facility with a scabies diagnosis, facility staff communicated with VCPH and CCL in a timely manner based upon the Reporting Requirements in Section 87211. Thus, based on evidence gathered throughout the investigation, the allegation is deemed unsubstantiated at this time.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC9099 (FAS) - (06/04)

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