567609954-5-24-2023-29-AS-KBUY-CSCPKH-20230531112311

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609954
Report Date: 05/24/2023
Date Signed: 05/24/2023 03:19:32 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
10/15/2021 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20211015125515

FACILITY NAME:	ARTESIAN OF OJAI, THE		FACILITY NUMBER:	567609954
ADMINISTRATOR:	MICHAEL O'NEILL		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:	05/24/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Michael O'Neill, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff is mishandling a resident's medication
Resident is not being properly fed while in care

INVESTIGATION FINDINGS:

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

LPA Angel Ascencio conducted the initial 10- day complaint visit on 10/19/2021 at 12:54 PM – 3:00 PM, LPA toured the facility inside and outside, conducted interviews with staff at 1:16 PM and 1:50 PM. interviews, obtained pertinent documents and reviewed resident files. LPA De Leon reviewed complaint, interviews and documentation collected. LPA De Leon interviewed Witnesses on 05/02/2023 at 3:30 PM and on 05/19/2023 at 1:07 PM. LPA De Leon requested and reviewed additional records on 05/19-05/21/2023.

On the allegation: Staff is mishandling a resident's medication. LPA De Leon reviewed staff notes for Resident 1 (R1) which revealed on 07/21/2021 R1’s leg was swollen and was given Aleve for pain, leg continued to be swollen with pain for several days until R1 was finally taken out on 08/09/2021 and returned with new medication orders, a staff note indicates on 08/09/2021 by Staff 1 (S1) R1 positive for
Continued 9099-C

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: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

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 6

Control Number 29-AS-20211015125515

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: 05/24/2023

NARRATIVE

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DVT, NP sent to ER for total check and shoulder evaluation, R1 put on blood thinner, Xarelto to start tonight, 2 person assist required. LPA De Leon reviewed the Medication Administration Records (MAR) on R1 for 08/09/2021 showing R1 did not get Xarelto on 08/09/2021 at 5:30 PM and did not get Xarelto on 08/10/2021 at 8:30 AM R1 was finally given Xarelto on 08/10/2021 at 5:30 PM. On 08/10/2021 staff notes indicate on 08/10/2021 at 6:00 AM around 10:15 PM staff gave R1 2 Acetaminophens, R1’s pain level 10. LPA De Leon reviewed MAR for Acetaminophen-Tylenol on 08/09/2021-08/10/2021 which only indicted 1 TAB was given on 08/10/2021 at 9:40 PM nothing was scheduled or given on 08/09/2021 and it is not noted when 2 Acetaminophen were given. R1 was prescribed Oxycodone HCI Oral Tablet 5MG on 09/13/2021 for 1 Tab PO every 4 hours PRN for pain, in reviewing records on R1’s MAR R1 was given Oxycodone on 09/21/2021 at 3:21 AM, 9:30 AM, 3:41 PM and 7:03 PM, the last two doses where given before the 4 hours and on 09/23/2021 MAR shows at 11:00 PM 1 tab of Oxycodone was given for leg pain and outcome was R1 sleeping and then again within 18 minutes at 11:18 PM another 1 tab of Oxycodone was given for pain and the outcome was R1 was ok. Based on the evidenced the allegation is deemed Substantiated at this time.

On the allegations: Resident is not being properly fed while in care. LPA De Leon reviewed staff notes indicating R1’s Pre-Appraisal dated 05/25/2021 states R1 is unable to care for self, R1 is total care, no dietary limitations, physical disabilities R1 is total care, mental conditions R1 has confusion at times, forgetfulness, total care in a geri chair, loves to be social, out of bed all day, non-ambulatory, uses wheelchair needs assistance getting in and out, resident does not use a walker, R1 requires assistance getting in and out of bed, R1 requires dressing, bathing, personal hygiene and hair care assistance, requires assistance with transfers, R1 requires eating assistance, R1 needs toileting/wears briefs changing every 2 hours and repositioned while in bed, R1 requires assistance with activities R1 needs to be brought to the activities area and taken back after finished, R1 has confusion, forgetfulness and night supervision is needed.
Staff notes indicate R1 moved into the facility on 06/03/2021, R1 is in a geri chair, and total care with all ADL’s. The staff notes reviewed did not ever indicate R1 was feed or had any help with feeding by the facility caregivers. The notes indicate that R1 had a private caregiver that spent time with R1 often and would stay in R1’s room and notes mentioned the private caregiver feeding R1 at times.
The review of R1’s Individual Service Plan dated 06/03/2021 indicated Non-Ambulatory, 3 needs with Ambulation Ambulatory assistance, wheelchair assistance and bed transferring assistance and 19 needs with Activities of Daily Living (ADL) Dressing, bathing, grooming, personal hygiene, transferring, eating, toileting, activities, night supervision, confusion, forgetfulness, incidental health and medical care assistance, medication assistance, laundry, household tasks, financial assistance as well as mental assistance.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 29-AS-20211015125515

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: 05/24/2023

NARRATIVE

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R1’s LIC 602 Physicians report dated 07/14/2021 indicated incontinent, geri chair, not able to bathe self, dress/groom self, able to feed self, not able to care for toileting needs or manage cash resources, not able to administer or store own medications and PRN’s, and not able to transfer to and from bed, non-Ambulatory.
W1’s interview revealed W1 had another issue with residents eating and staff feeding residents, W1 can say the quality of the food is not that bad but several residents cannot eat by themselves, lack capacity to feed selves, or they can't get the utensils to their mouths properly. W1 is at the facility during lunch quite often and W1 watches several residents struggling to eat, the staff do not help them, they serve them and then pick up the plates even when most of the resident's would try to continue to eat the remainder of the food. W1 goes at lunch time so W1 can help R2 eat. W1 or R1’s other family goes often at dinner time and sees most of the residents playing with the food not eating it. The facility needs additional staff to sit in dining and help the residents eat meals. W1 said another resident’s family moved the resident out of the facility due to food and feeding issues.

W2’s interview revealed the staff that the facility had cooking were caregivers and the staff did not know how to cook, the facility did not have separate kitchen and housekeeping staff to work, the food was so bad, R3 was on a low sodium diet but the staff never incorporated food for R3’s diet. The staff lacked the knowledge of what a low sodium diet consisted of. W2 brought food in for R3 all the time so R3 would eat, the facility decided R3 was a choking hazard after one of R3’s falls that W2 was not inform about and put R3 on a pureed diet without a doctor’s order. W2 had the doctor write an order for a normal low sodium diet and started bringing in real food for R3 to eat.

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: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 29-AS-20211015125515

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: 05/24/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/31/2023 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	(a)A plan for incidental medical and dental care...The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care,...(4)The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to review and update facility medications policy if needed, train all Wellness staff, Medication-Technicians on the facility medication policy and procedures as well as have Hospice Agency train all Wellness staff and Guides on hospice, medication, orders, policy and procedures
	8 9 10 11 12 13 14	Based on interviews and record review the Licensee did not comply with the above regulation R1 was not getting medications as needed and doctors’ medication orders were not followed which poses a potential health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14
Type B 05/31/2023 Section Cited CCR 87555(b)(18)	1 2 3 4 5 6 7	(b)The following food service requirements shall apply:(18)Sufficient food service personnel shall be employed, trained and their working hours scheduled to meet the needs of residents. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to train all current kitchen staff in preparation, handling, cooking, serving, and storage of food , all requirements of regulation 87555, facility policy and procedures send up to date LIC 500 ientifying kitched staff and provide with proof of trianing to CCL.
	8 9 10 11 12 13 14	Based on interview and record review the Licensee did not comply with the regulation above R1 was accepted into care requiring help with feeding and the facility did not employ qualified kitchen staff requiring caregivers time away from helping the residents which poses a potential health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14	The facility is required to have additional kitchen staff separate from staff that provide resident care due to licensed capacity.

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: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 6

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
10/15/2021 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20211015125515

FACILITY NAME:	ARTESIAN OF OJAI, THE		FACILITY NUMBER:	567609954
ADMINISTRATOR:	MICHAEL O'NEILL		FACILITY TYPE:	740
ADDRESS:	203 E EL ROBLAR DRIVE		TELEPHONE:	(805) 798-9305
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	72	CENSUS:	DATE:	05/24/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Michael O'Neill, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident is receiving services not authorized
Staff do not have planned activities for a resident

INVESTIGATION FINDINGS:

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

LPA Angel Ascencio conducted the initial 10- day complaint visit on 10/19/2021 at 12:54 PM – 3:00 PM, LPA toured the facility inside and outside, conducted interviews with staff at 1:16 PM and 1:50 PM. interviews, obtained pertinent documents and reviewed resident files. LPA De Leon reviewed complaint, interviews and documentation collected. LPA De Leon interviewed Witnesses on 05/02/2023 at 3:30 PM and on 05/19/2023 at 1:07 PM. LPA De Leon requested and reviewed additional records on 05/19-05/21/2023.

On the allegation: Resident is receiving services not authorized. LPA De Leon reviewed R1’s records and a note was made by staff that R1’s RP was considering Hospice at this time. R1 started receiving hospice services on 10/14/2021 and the records indicated R1’s RP signed these records authorizing services. Based on the evidence this allegation is deemed Unsubstantiated at this time.
Continued 9099-C

Unsubstantiated

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: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 29-AS-20211015125515

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: 05/24/2023

NARRATIVE

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On the allegation: Staff do not have planned activities for a resident. LPA De Leon reviewed the scheduled activities calendar for the month of September and October of 2021. The activities calendar lists 4 or more activities offered per day to the residents in care. The activities listed range from Pilates, healing movements, creative arts, puzzles, swim, crossword puzzles, documentaries, bingo, ring toss, dominoes, movies, chair exercise, checkers, TV game shows, chef cooking presentations, happy hour, corn hole, scenic drives, water aerobics, walking club, card and board games, and music therapy offering 4 or more activities during different times a day.

LPA De Leon reviewed staff notes for R1 indicating on 06/11/2021 R1 played Bingo, on 06/18/2021 played dominoes out by the garden, 07/09/2021 sat outside and enjoyed music with other residents, on 07/21/2021 attended Art class, 07/23/2021 listen to music in the dining room with other residents, 07/23/2021 sat outside with private caregiver, 07/29/2021 socializing with residents, 07/31/2021 snacks and puzzles, 08/01/2021 watched shows with residents, 08/13/2021 group time in the dining hall, 08/18/2021 participated in exercises, 08/27/2021 watched TV with Caregiver. The notes also indicate regular family visits with R1 and daily/nightly time spent with R1’s private caregiver. Based on the lack of evidence this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and report 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: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC9099 (FAS) - (06/04)

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