567609954-4-17-2023-29-AS-KBUY-CRA3RN-20230426182901

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609954
Report Date: 04/17/2023
Date Signed: 04/17/2023 04:52:31 PM

Substantiated

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
04/01/2021 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20210401111205

FACILITY NAME:	ARTESIAN OF OJAI, THE		FACILITY NUMBER:	567609954
ADMINISTRATOR:	BROWN, MARY THERESA		FACILITY TYPE:	740
ADDRESS:	203 E EL ROBLAR DRIVE		TELEPHONE:	(805) 798-9305
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	72	CENSUS: 47	DATE:	04/17/2023
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Mike O'Neil, Administrator		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff failed to meet the resident needs
Staff curses in the presence of residents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) De Leon conducted a subsequent complaint visit to the facility above to deliver final findings of the allegations. LPA met with Administrator Mike O’Neil at 10:50 AM and explained the purpose of the visit.

LPA Rosales conducted the initial Complaint visit on 04/09/2021 at 8:25am virtually toured the facility, conducted telephonic interviews with Administrator at 8:34 AM and requested copies of pertinent documents, interviewed additional staff at 9:13am. On 04/28/2021 an additional complaint was filed. On 04/30/2021 Administrator was interviewed at 2:23 PM and staff at 12:07 PM. On 04/09/2021 and on 05/07/2021 documents requested were received.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023

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-20210401111205

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: ARTESIAN OF OJAI, THE	FACILITY NUMBER: 567609954
	VISIT DATE: 04/17/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

On 06/07/2021 staff was interviewed at 2:21 PM. On 06/15/2021 LPA’s Rosales and Guzman-Chavez conducted a subsequent complaint visit at 10:04 AM toured the facility, interviewed staff at 11:52 AM, 12:09 PM, 12:53 PM, 1:34 PM, 1:44 PM, 2:13 PM, and 2:21 PM. LPA Rosales interviewed resident at 1:21 PM on 06/15/2021. On 06/17/2021 documentation received by LPA Rosales. On 08/02/2021 LPA Ascencio interview witness. On 08/24/2021 LPA Rosales interviewed staff at 9:22am. LPA Rosales reviewed documentation on 08/26/2021. LPA Rosales interviewed additional staff on 03/09/2022 at 9:22 AM, 9:37 AM. LPA Rosales made observations on another complaint visit on 03/10/2021 and interviewed staff at 2:00 PM and 2:28 PM relevant to this complaint. LPA De Leon was reassigned the complaint investigation

On the allegation: Staff failed to meet the resident needs. LPA’s interviews revealed it was known by 8/12 staff interviewed that R1 had behaviors. Interview with Administrator on 04/09/2021 stated that they have 1 Resident (R1) that has had some difficulty with behaviors to manage. Five staff reported R1 would yell and scream daily. Three staff reported R1 would bang or pound R1’s head on the wall. Two staff stated R1 throws things and slams doors. 2 staff stated R1’s medications were the problem either not getting them on time or being out of them. According to staff notes R1 did have prescriptions/PRN’s to manage behaviors and pain, but no medication records for R1 were provided to CCL for review. Staff notes indicate R1 would have behaviors and medications/PRN’s were given. And other times notes would indicate R1’s behavior with no PRN/medications given. Staff notes reviewed from 02/05/2021-04/28/2021 R1 had 76 entries of behaviors.
LPA De Leon reviewed facility incident report dated 11/17/2020 where R1 was taken to the ER on 11/17/2020 and a tooth abscess was noted. Facility did not provide any records of any dentist appointments from 11/2020-03/2021. S1 stated on 04/09/2021 that R1 had a dentist appointment on 04/05/2021 where R1 had deep cleaning, red gums and 1-2 teeth had an abscess. Administrator and 1 staff stated that they believe that the issues are related to dental pain.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 29-AS-20210401111205

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: ARTESIAN OF OJAI, THE	FACILITY NUMBER: 567609954
	VISIT DATE: 04/17/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Administrator stated that the resident had an appointment to see a dentist. Administrator stated that the Nurse Practitioner comes to the facility to see the resident and thinks that the behaviors are pain related. R1 had pain, swelling and issues with gait in R1’s legs according to staff notes in the facility records obtained. R1 had seizures and was taken to the ER on 02/23/2021, this was reported to CCL. Based on Complaint # 29-AS-20210727094739 R1 had another ER visit on 07/17/2021, this was also reported to CCL. During the investigation in that complaint S1 was interviewed at 11:23 AM, S1 stated that R1 had an unwitnessed fall on 7/26/2021. S1 mentioned that R1 did not hit their head but was experiencing pain in R1 groin area. S1 also added the R1 had gone to the hospital the week prior for another fall that caused an injury to R1 head on 7/17/2021 and that the R1 is now using walker to ambulate. Witnesses interviewed stated they did not know about R1’s falls on 07/22/2021, 2 falls on 07/26/2021, and 1 on 07/27/2021. One witness said they learned about the 07/17/2021 fall when they received R1’s medical bill. Another Witness stated they were contact on the 07/17/2017 fall, the interview also revealed if the family would have been made aware of the frequency of falls, they would have liked to have sought medical attention. R1 had several falls at the facility and according to staff interviews 911 was not called and ER visits were not made on some of those visits that should have been. Based on the evidence R1’s needs for care and supervision were not being met by the facility therefore this allegation is deemed Substantiated at this time.

On the allegation: Staff curses in the presence of residents. LPA’s interviewed staff which revealed several staff were talking inappropriately in front of residents, visitors, and other staff. According to Administrator staff 10 (S10) was counseled on 02/18/2021 and 03/24/2021 for speaking inappropriately in Spanish with other staff. Staff interviews revealed that S10 would play curse music that was not appropriate in the common areas of the residents.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 29-AS-20210401111205

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: ARTESIAN OF OJAI, THE	FACILITY NUMBER: 567609954
	VISIT DATE: 04/17/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Staff interviews revealed S10 would talk about resident 2’s (R2) condition with genitals inappropriately to other staff. Staff interviews revealed they heard S10 curse in the presence, speak about genitals and act inappropriately to R2. S10 was terminated from employment on 04/18/2021 after taking beverages from a resident’s room. LPA observed a copy of email in staff files regarding staff 4 (S4) cursing at other staff and residents were complaining. Administrator stated R3 complained about S4 they do not recall what the staff said as they did not document it but it was something that they should not have said. Staff interviews revealed S4 cursing at R3. S4 stated they have learned to be a lot kinder to R3. Based on the evidence this allegation is deemed Substantiated at this time.

Exit interview conducted, deficiencies cited, copy of report and appeal rights printed for Administrator.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 29-AS-20210401111205

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: ARTESIAN OF OJAI, THE	FACILITY NUMBER: 567609954
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/17/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/19/2023 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	(f)Basic services shall at a minimum include:(1)Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement has not been met evidenced by:	1 2 3 4 5 6 7	Administrator agreed to hold additional training of all staff on all shifts on 87464 Basic Services, 87465 Incidental Medical and Dental care,
	8 9 10 11 12 13 14	Based on interviews/record review the licensee did not comply with the regulation above, R1 was having behaviors that were not being managed, R1’s medications were not being given or refilled properly, R1’s medical and dental needs were not being met which poses an immediate Health, safety, and personal rights risk to residents in care	8 9 10 11 12 13 14	87705 Care of persons with Dementia, 87411 Personnel requirements, 87707 Training requirements, Mandated reporting and all facilities policies/procedures covering these topics set forth in the facilities plan of operation. Provide proof of trainings to CCL.
Type A 04/19/2023 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1)To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to hold additional training with all staff on all shifts on Personal Rights 87468.1 and 87468.2, facility policy and procedures for reporting
	8 9 10 11 12 13 14	Based on interviews/records review the licensee did not comply with the regulation above Staff S10 & S4 cursed and or used inappropriate language in the presence of residents and directly to the residents which poses an immediate personal rights risk to residents in care.	8 9 10 11 12 13 14	personal rights violations and the facilities plan of operation on these subjects. Provide completion of all staff training with all staff signatures and an up to date LIC 500 for all staff working at the facility to CCL.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5