565802467-6-19-2023-29-AS-JAPL-CT2LLT-20230622085141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802467
Report Date: 06/19/2023
Date Signed: 06/19/2023 11:43:40 AM

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
05/20/2021 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20210520121117

FACILITY NAME:	PALMS AT BONAVENTURE ASSISTED LIVING, THE		FACILITY NUMBER:	565802467
ADMINISTRATOR:	MCCAULEY, BRANDY		FACILITY TYPE:	740
ADDRESS:	111 N WELLS ROAD		TELEPHONE:	(805) 647-0616
CITY:	VENTURA	STATE: CA	ZIP CODE:	93004
CAPACITY:	121	CENSUS: 99	DATE:	06/19/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Brandy McCauley		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff mishandle the residents medications while in care
Staff is administering unauthorized medications to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a subsequent complaint visit. The LPA met with Executive Director Brandy McCauley and explained the reason for the visit.

On 05/24/2021, LPA’s Kelly Dulek and Martha Guzman-Chavez conducted an initial visit from 10:05 a.m. – 1:00 p.m., where they spoke with staff, conducted a tour, gathered documents, and conducted a medication audit. On 6/13/2023, LPA Smith interviewed nine (9) staff from 10:00 a.m. - 12:00 p.m., conducted a medication audit from 12:15 p.m. - 1:45 p.m., and interviewed four (4) residents from 1:50 p.m. - 2:30 p.m. Today, LPA Smith interviewed five (5) staff from 9:40 – 10:30 a.m., and interviewed three (3) residents from 10:35 a.m. – 11:20 a.m.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023

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-20210520121117

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: PALMS AT BONAVENTURE ASSISTED LIVING, THE	FACILITY NUMBER: 565802467
	VISIT DATE: 06/19/2023

NARRATIVE

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Regarding the allegation: Staff mishandle the residents medication while in care
It was alleged that staff are failing to assist residents with the self-administration of medications, and that there were many medication errors, as staff would allegedly give residents the wrong medication or an incorrect dosage. LPAs conducted a medication audit on 5/24/2021 and 6/13/2023, and the LPAs were unable to uncover evidence that the staff had failed to properly assist residents with the self-administration of medication. The Medication Administration Record (MAR) indicated that medications for the residents had been given as prescribed. The LPA also checked resident medications for expiration dates and instructions and the LPA uncovered minimal discrepancies. The LPA reviewed facility incident reports, and the LPA was unable to uncover incident reports as it related to known medication errors. Interviews revealed that staff did not recall specific occurrences where medication errors occurred, and staff claimed that when residents asked for their as-needed (PRN) medication, that staff responded. Residents did not communicate any concerns as it related to receiving their medications, and claims that they received their PRN medication once requested. Staff could not recall a time when a resident received too much medication. Based on the information from interviews, records review, and medication audits, there is insufficient evidence to support the claim that staff mishandle resident medication. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff is administering unauthorized medications to residents
It was alleged that if residents requested pain medication, they would receive the house supply of Tylenol 325mg, even if the residents had a prescription for pain medication at a different strength. Staff indicated that the facility had a house supply of Tylenol and noted that it was 325mg. Staff indicated that a number of residents have an order for Tylenol as-needed (PRN), and staff noted that if the resident did not have their own medication from the pharmacy, they could use the house supply of Tylenol. The LPA conducted a medication audit for residents that had a PRN for pain medication, and records indicated that the order for pain medication was either 325mg or 650mg. Medication audit and records indicated that if the facility used the facility supply of Tylenol, residents received the appropriate dosage of pain medication as requested. Interviews from both staff and residents indicated that staff would assist residents with the self-administration of PRN medication as needed, and as prescribed by the resident’s doctor. Based on the information from interviews, records review, and medication audits, there is insufficient evidence to support the claim that staff administered unauthorized medication to residents. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023

LIC9099 (FAS) - (06/04)

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