567609954-5-3-2023-29-AS-KBUY-CSCLPB-20230531085539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609954
Report Date: 05/03/2023
Date Signed: 05/03/2023 04:37:47 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
06/08/2021 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20210608163749

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: 46	DATE:	05/03/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Mike O'Neil, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not seek medical attention for resident in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) De Leon conducted a subsequent Complaint visit to the facility above to deliver final findings of the allegation. LPA met with the new Administrator Mike O’Neil and explained the purpose of the visit.

LPA’s Rosales and Guzman-Chavez conducted the initial 10-day complaint visit at 10:04 AM – 3:57 PM, reviewed resident records, interviewed random staff and residents, and obtained copies of pertinent documents. Interviews were conducted with staff on 06/15/2021 at 11:40 AM, 12:01 PM, 12:41 PM, 1:28 PM, 1:41 PM, 1:55 PM, 2:00 PM, 2:18 PM, 2:33 PM, and resident interview at 11:33 AM. LPA received documentation on 06/07/2021 and 06/10/2021. LPA Rosales conducted staff interview on 10/04/2021 at 1:17 PM. LPA Rosales interviewed witness at 10:37 AM. LPA Rosales conducted a subsequent complaint visit on 10/05/2021 at 11:06 PM – 4:00 PM, toured facility with staff and interviewed with staff at 2:35 PM. LPA Deleon reviewed complaint, interviews, and documentation on 04/27/2023.

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: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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-20210608163749

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: 05/03/2023

NARRATIVE

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On the allegation: Staff did not seek medical attention for resident in a timely manner. LPA Rosales interviewed witness 1 (W1) which revealed R1 moved into the facility on 05/24/2021, that R1 had a scab on 5/24/21 and W1 noticed that it was looking bad so W1 went to the office and asked to have the Nurse S11 look at it. W1 stated that they do not know what caused the wound, that R1 fell 2 or 3 weeks before R1 moved into the facility, R1 is not diabetic but does have circulation problems, the hospital said that it was infected with maggots on 06/03/2021. S3’s interviewed revealed that S3 saw the R1’s right leg was swollen and R1 was limping after breakfast, R1 went back to R1’s room, S3 went to the R1’s room to check on R1’s ankle, R1’s ankle was oozing and S3 saw something moving, S3 turned on the flashlight and saw maggots in R1’s open wound, S3 stated that they called the Med Tech S10, S10 took a video of R1’s wound and sent it to the Nurse S11 on 6/3/21. S3 stated that all the Nurse said was to put a bandage over it, S10 put a bandage over it, S10 went back to put another gauze and noticed that the wound was getting bigger, Administrator Therese called W1 to tell W1 about the wound and W1 scheduled a doctor's appointment for 3:15pm, because R1 could not walk and was in alot of pain R1 went to the hospital that day and was out for a couple of days. S10’s interview revealed that on 6/3/21 S10 was working as the Med Tech in the Matilija building, S10 saw an open wound at approximately 9 am on R1’s ankle with maggots, S10 stated that this was the first time S10 had observed a wound on R1’s ankle, the wound was approximately the size of a dime, S10 let Therese (Administrator) know about R1’s wound because R1 was complaining of pain, S10 showed Administrator the video with the maggots, Administrator got ahold of W1 who made an appointment for R1 to see the doctor at 2:30 pm, the wound grew bigger in the afternoon around 2 pm S10 told Administrator that R1 was in alot of pain and R1 needs to go now to the ER, Administrator agreed and took R1 to the ER. S5’s interview revealed W1 asked Administrator to ask S11 to look at R1’s wound the day before R1 went to the ER, Administrator wrote an observation note on the day R1 went to the hospital indicating R1 had a weeping wound even though it was filled with maggots, R1 was gone around 2 nights, it was Thursday 6/3/21 is when S3 found the wound and called S10 to look at it as S11 was not there. S2’s interview revealed the Nurse S11 was told by W1 that R1 had a wound on the right ankle, S2 was not sure if anyone assessed the wound,

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20210608163749

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: 05/03/2023

NARRATIVE

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it was Thursday 6/3/21 when the R1 was complaining about R1’s ankle and S10 looked at the R1’s ankle and the wound was moving, S10 called the Nurse S11 and S11 told S10 to put some ointment on it and cover it, S10 told the Nurse S11 that there were maggots, S10 put ointment and wrapped it, the maggots got really mad, R1 was in so much pain S10 told Administrator S10 was sending R1 out so Staff 1 (S1) and S10 got R1 in the car and Administrator drove R1 to the ER. S1’s interview revealed R1 had maggots in R1’s wound, S3 sent S1 a video of the wound with maggots on 6/3/21, S3 told the nurse S11 about it that day, R1 went to the hospital on 6/3/21, and Administrator took R1 to the hospital. R1’s interview revealed R1’s ankle got all infected and someone there wrapped it, and R1 does not know if staff are taking care of it. S11’s interview reveals S11 did a head to toe assessment when R1 moved in, S11 was not told by W1 that R1 had a wound, on 6/3/21 S10 pointed it out to S11 and that it was moving, no staff were aware of R1’s wound prior to 6/3/21 R1 had not complained of pain prior to that day, R1 was getting assistance with showering but not with getting dressed, staff that showered R1 never saw it, R1 was sent to the ER that afternoon because R1 was complaining of pain. LPA De Leon reviewed records and according to R1’s appraisal R1 required assistance with showers and standby assistance with dressing. LPA De Leon reviewed R1’s Hospital Discharge Summary of Care which revealed R1 was discharged on 06/06/2021 with a diagnosis of open ankle wound and symptomatic urinary tract infection with a plan of care. LPA reviewed R1’s Home Health records dated 06/08/2021 which revealed R1 was being provided care for open wound right ankle, symptoms controlled with difficulty, affecting R1’s daily functioning, R1 needs ongoing monitoring, and facility will do daily wound care. LPA De Leon reviewed staff notes and no notes reveal staff observed the wound on R1’s ankle prior to 06/03/2021, notes do not indicate daily wound cleaning on 06/07/2021 and 06/13/2021. Interviews with W1, S2 and S5 interviews revealed S11 was asked prior to 06/03/2021 to look at R1’s ankle, staff interviews revealed R1 was observed after breakfast to be limping with a swollen ankle, videos of R1’s wound infested with maggots was sent around 9 AM on 06/03/2021 to S11, Administrator and S1, S10 then showed the Administrator video later in the day due to R1’s increase of pain and the wound getting larger, R1 was not taken to the ER until after 2:00 PM based on the evidence in this case allegation is deemed Substantiated at this time.

Exit interview conducted, deficiency 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: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20210608163749

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: 05/03/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/10/2023 Section Cited CCR 87468.1(b)(8)	1 2 3 4 5 6 7	(b)...(8)Deny or restrict medical or nonmedical care that is appropriate to a resident’s organs and bodily needs, or provide medical or nonmedical care to the resident in a manner that, to a similarly situated reasonable person, unduly demeans the resident’s dignity or causes avoidable discomfort. This requirement was no met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to hold training on personal rights and procedures for timely medical attention with all staff and provide proof of training to CCL.
	8 9 10 11 12 13 14	Based on interviews and record review the licensee did not comply with the above regulation R1 had a wound with pain, maggots and timely medical attention was not provided which poses a potential personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC9099 (FAS) - (06/04)

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