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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567609954
Report Date: 09/05/2023
Date Signed: 09/05/2023 01:54:58 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
04/07/2023 and conducted by Evaluator Brian Phillips
COMPLAINT CONTROL NUMBER: 29-AS-20230407163919
FACILITY NAME:ARTESIAN OF OJAI, THEFACILITY NUMBER:
567609954
ADMINISTRATOR:MICHAEL O'NEILLFACILITY TYPE:
740
ADDRESS:203 E EL ROBLAR DRIVETELEPHONE:
(805) 798-9305
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY:72CENSUS: 41DATE:
09/05/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Amber Winterstein, AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff do not assist with the self-administration of resident's medications as prescribed.
Facility staff do not respond to resident’s call button.
INVESTIGATION FINDINGS:
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This is an amended report. Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced subsequent complaint visit on 09/05/2023 to issue final findings for the allegations above. LPA arrived at the facility and announced the purpose of the visit. LPA met with Amber Winterstein, Administrator of the facility.

On the allegation: Staff do not assist with the self-administration of resident's medications as prescribed. It was alleged that the pharmacy providing the medications to the facility for residents was unable to fill a specific medication due to pharmacy hours and weekend schedule. The allegation states that facility staff were not sensitive to the pain this would cause in a resident without their medication.

On 08/17/2023, LPA received documentation about R1’s medications including the Medication Administrative Report (MAR) and the Centrally Stored Medication & Destruction Log. Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023
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 4
Control Number 29-AS-20230407163919
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 567609954
VISIT DATE: 09/05/2023
NARRATIVE
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 LPA also received staff notes from the facility about R1’s medications, such as when they called for refills, or copies of fax/email requests for refills. Until 02/16/2023, the specific narcotic medication for R1 indicated in the allegation was a Pro Re Nata (PRN) or an “as needed” medication. Until 02/16/2023, the instructions for the medication indicated that R1 was to take 1 tab of medication every 4 hours as needed for pain. However, on 02/16/2023, the instructions for the medication changed so that R1 was to take 1 tab of medication every 4 hours routine during the day. The MAR for the facility shows that the medication was given to R1 routinely as prescribed every 4 hours during the months of February and March 2023 unless it was specifically refused by R1 which occurred individually 3 times during March 2023. According to the Centrally Stored Medication and Destruction Record, R1 had this specific narcotic medication filled by the pharmacy on 02/28/2023 for 180 tabs of medication routinely given every 4 hours, or 6 times a day. The schedule of this narcotic medication would mean that the next refill for R1 would be 1 month or 30 days after 02/28/2023. The date at which the narcotic medication should have been filled for R1 would have been 03/29/2023 or 03/30/2023 depending on whether the fill date is counted. Either way, 03/29/2023 was a Wednesday and 03/30/2023 was a Thursday. R1 indicated that the Pharmacy could not fill the prescription over the weekend of 04/01/2023 and 04/02/2023, but the medication should have been filled prior to the Friday of 03/31/2023 when R1 was out of the medication, went into withdrawal, and the pharmacy closed for the weekend (Saturday & Sunday). Administrator & Staff interviewed could not provide a reasonable explanation as to why R1's medication was not refilled in a timely manner.

Based on the information obtained, there is sufficient evidence to prove the allegation. Therefore, the allegation is deemed Substantiated at this time.

On the allegation: Facility staff do not respond to resident’s call button. It is alleged that residents call for help with the call button and no staff members respond or come to the resident’s rooms.

On 04/13/2023, LPA received documented records of the facility call button system usage for each resident for 04/07/2023 and 04/08/2023. The facility Call History documentation lists the call type: Pendant call or emergency call, Area, Room, Floor, Call Time, Wait Time, and name of the resident calling. From the documented facility call history, all resident call button usage was responded to by staff members. Wait time for each call varied on type of call, being Pendant or Emergency calls. On 05/31/2023, LPA interviewed residents about the allegation and no resident interviewed by the LPA stated that they had been ignored by the staff of the facility when they pressed their call button. R1 had 6 pendant calls during this period, with 3 of the pendant calls occurring on 04/07/2023 & 2 pendant calls occurring on 04/08/2023. Contd. 9099-C

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20230407163919
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 567609954
VISIT DATE: 09/05/2023
NARRATIVE
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The wait times for the pendant calls of R1 on 04/07/2023 started with responses between 6 minutes-21 minutes, to the last 2 pendant calls on 04/07/2023 having response times of 3 hours each. The 3-hour response times occurred at 6:31am and 4:48pm. There is no evidence of inadequate staffing during those hours on 04/07/2023, and long wait times are attributed to the very busy schedule of the facility during those hours. The facility call button history documentation shows that the wait times for R1 became increasingly lengthy in proportion to the number of calls R1 made on 04/07/2023. The Call Button History Documentation shows that other residents had a wait time from less than a minute to approximately half an hour.

Based on the information obtained, there was sufficient evidence to prove the allegation. Therefore, the allegation is deemed Substantiated at this time.

The facility will be cited with 1 Type A deficiency for Incidental Medical and Dental Care, Title 22 (22 CCR) Division 6, Chapter 8 Section 87465(a)(4). The facility will also be cited with 1 Type B deficiency for Additional Personal Rights of Residents in Privately Owned Facilities, Title 22 (22 CCR) Division 6, Chapter 8 Section 87468.2(a)(8).



Exit interview conducted, citation issued, appeal rights and copy of the report provided to the facility Administrator.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 29-AS-20230407163919
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 567609954
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/06/2023
Section Cited
CCR
87465(a)(4)
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Section 87465(a)(4) Incidental Medical and Dental Health Services. (a) Plan for incidental medical and dental care developed by facility. Plan shall...compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed.
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The Licensee agreed to schedule a Staff training on medication management and medication record keeping. The facility will provide evidence to the LPA that these trainings are scheduled. The facility agreed to implement medication fill dates in the electronic medication record system.
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This requirement was not met based on interviews and record review; the licensee did not comply with the section cited above when Staff failed to refill a resident’s medication in a timely manner, which posed an immediate health and safety risk to residents in care.
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Type B
09/29/2023
Section Cited
CCR
87468.2(a)(8)
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Section 87468.2(a)(8) Add'l. Personal Rights of Residents in Privately Owned Facilities. (a) …residents...shall have following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and... abuse.
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The Licensee agreed to schedule a Staff training on the facility call button system and the personal rights of residents in care. The facility will provide evidence to the LPA that this training has been scheduled.
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This requirement was not met based on interviews and record review; the licensee did not comply with the section cited above when Staff failed to respond to resident’s call button in a timely manner multiple times, which posed a potential health and safety risk to residents in care.
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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 BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4