565850158-8-14-2023-29-AS-DPEA-CUWPX5-20230821114147

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850158
Report Date: 08/14/2023
Date Signed: 08/14/2023 04:57:45 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
05/23/2022 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20220523161429

FACILITY NAME:	AASTA ASSISTED LIVING		FACILITY NUMBER:	565850158
ADMINISTRATOR:	GUTIERREZ, ROBERT		FACILITY TYPE:	740
ADDRESS:	903 CARMEN DRIVE		TELEPHONE:	(805) 586-4191
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY:	130	CENSUS: 64	DATE:	08/14/2023
		UNANNOUNCED	TIME BEGAN:	12:04 PM
MET WITH:	Monica Reyes		TIME COMPLETED:	05:05 PM

ALLEGATION(S):

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Facility staff did not assist with resident's medication as prescribed
Facility staff are not trained for the job assigned to them
Insufficient staffing

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a subsequent complaint inspection with the purpose of delivering findings for the allegations listed above at 12:04PM. The LPA met with Administrator Monica Reyes and explained the reason for today's visit. Entrance interview conducted.

During today's visit, LPA interviewed residents from 02:33PM to 03:05PM. During an initial complaint visit conducted on 06/01/2022, LPA toured the facility including kitchen and all food service areas with Administrator at 12:40PM, conducted staff and resident interviews at 12:03PM, 12:47PM, and 1:52PM. LPA also gathered copies of pertinent documents. Throughout the course of the investigation, LPA reviewed all pertinent documents and interviewed staff and residents during unrelated facility visits. The following was then determined:
Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023

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-20220523161429

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: AASTA ASSISTED LIVING	FACILITY NUMBER: 565850158
	VISIT DATE: 08/14/2023

NARRATIVE

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Allegation: "Facility staff did not assist with resident's medication as prescribed:"

It was alleged that Resident #1 (R1) was not assisted with their insulin and diabetes medication. LPA interviewed R1 and their family member, as well as other facility residents and facility staff. Interviews revealed that at the time of the complaint allegation, the facility employed Licensed Vocational Nurses (LVNs) to provide diabetic care to all applicable residents. At the time of the complaint and through 08/03/2022, there were at least 2 LVNs employed at the facility who administered all diabetic medications. After 08/03/2022, most residents' medications were changed to oral diabetes medications for self-administration. The residents requiring injections were able to be assisted with to hand-over-hand administration of injectable medications. As thus, medication technicians were able to assist residents with diabetes medication assistance and LVNs were not needed full time at the facility. LPA reviewed medication administration record (MAR) for R1, which indicated R1 refused blood sugar check on 5 dates in May 2022. R1 also refused their bedtime insulin pen injection on 05/21/2022 and 05/22/2022. Interviews revealed that R1's physician was informed of R1's medication refusal. Interview with R1 and other residents revealed that medications are offered regularly and on time. Staff interviews revealed that R1 wasn't always compliant with taking their medications as ordered, but they were offered daily and documented when refused. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that "facility staff did not assist with resident's medication as prescribed" is deemed UNSUBSTANTIATED at this time.

Allegation: "Facility staff are not trained for the job assigned to them:"

It was alleged that facility staff are not properly trained for medication administration, specifically related to diabetes medications. LPA reviewed records and interviewed facility management and staff regarding training procedures. All training records for medication technician staff reviewed were compliant with regulation. At the time of the complaint allegation, only LVNs were administering diabetes medications. As they are licensed medical professionals, additional medication training was not required per regulation. Following the change to medication technicians assisting residents with self-administration of injectable medications, an additional in-service training related to diabetes care was provided for all facility medication technicians. Interviews revealed that staff complete training on both a computer system and shadowing prior to administering any medications. Training practices reviewed during the course of the investigation were Report Continued on LIC 9099-C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220523161429

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: AASTA ASSISTED LIVING	FACILITY NUMBER: 565850158
	VISIT DATE: 08/14/2023

NARRATIVE

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compliant with regulation at that time. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that "Facility staff are not trained for the job assigned to them" is deemed UNSUBSTANTIATED at this time.

Allegation: Insufficient staffing:"

The complaint alleges that the facility does not employ sufficient staffing, resulting in long wait times for residents when they push their call buttons. LPA reviewed the facility staff schedules and conducted interviews. Staff interviewed reported that as the facility census is lower than it has been, therefore less staff needed. Depending on how busy the care staff are determines the wait times. Additionally, there are a few residents that require a 2-person assist and when the staff are assisting those residents, other residents may have to wait a bit longer for a response, but this scenario doesn't occur often. During the daytime, care staff, management, and med techs are all available to assist residents when needed. At night, there are less residents requiring assistance as most residents are sleeping, therefore, less staff are employed during those hours. R1 indicated staff do come and check on their incontinence needs every 2 hours during the night shift. Interview with R1 revealed they could not reach their pull cord when they fell, resulting in R1 calling 9-1-1 for assistance. R1 indicated the problem was not with insufficient staffing, but rather with the location of the pull cord when R1 fell. R1 acknowledged that the facility staff had given R1 a longer pull cord to try to alleviate the problem, but that the location of R1's bed made it difficult to keep the pull cord in an easily accessible spot. When LPA asked R1 about moving their bed to make the pull cord more accessible, R1 refused. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation, therefore, the allegation "Insufficient staffing" is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023

LIC9099 (FAS) - (06/04)

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