<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197604989
Report Date: 06/09/2022
Date Signed: 06/09/2022 03:35:05 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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/14/2020 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20200814090319
FACILITY NAME:DURANDO HOME IIFACILITY NUMBER:
197604989
ADMINISTRATOR:DONNA DURANDOFACILITY TYPE:
740
ADDRESS:38757 37TH STREET EASTTELEPHONE:
(661) 266-0551
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:4CENSUS: 3DATE:
06/09/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Richard DurandoTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident developed a stage 3 pressure injury while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This 9099 is being generated to reflect the Substantiated findings for the report that was issued on 5/19/22.

Licensing Program Analyst (LPA) Michael Cava conducted a subsequent visit to facility to deliver the findings of the above allegation. The 10 day visit was conducted by LPAs Elizabeth Arambulo and Melissa Spaeth. Complaint was then referred to Investigations Branch (IB) investigator Dennis Douglas. IB’s investigation consisted of facility file review, obtaining and reviewing medical records, interviewing clients, facility and hospital staff.

The investigation reveals as follows:

On or around 8/12/20, Resident 1 (R1) was transported to the hospital due to fever, later diagnosed with COVID 19. At the time of admission, R1 was observed with a pressure injury greater than a stage II.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
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 3
Control Number 31-AS-20200814090319
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: DURANDO HOME II
FACILITY NUMBER: 197604989
VISIT DATE: 06/09/2022
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
According to the administrator and facility staff, they’ve never observed R1 with any pressure injuries.

While conducting a record review, the IB investigator did not observe any medical records or notes documenting pressure injuries being maintained at the facility. On or around 09/17/2020, CCL received additional information from a credible source revealing that R1 was seen by home health to treat her wounds until the middle of July 2020, when her contract with home health was terminated. Licensee never attempted to replace R1’s home health after their contract ended in July 2020. Her last noted appointment with the physician was in April 2020.

Based on the information obtained, the facility has failed to address the resident’s needs by not attempting to replace her home health services to continue to treat her pressure injuries. Therefore, the allegation is Substantiated. Citations issued on the 9099D.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20200814090319
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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DURANDO HOME II
FACILITY NUMBER: 197604989
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/09/2022
Section Cited
CCR
87466
1
2
3
4
5
6
7
87466 Observation of the Resident
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. This requirement has not been met as evidenced
1
2
3
4
5
6
7
As POC, licensee will review this section with their staff and certify that they have read and understood regulation. As proof of POC, the licensee will submit signed documentation that they have reviewed and understand this section of the regulation. POC is due by 6/16/22.
8
9
10
11
12
13
14
by facility staff failing to observe resident’s pressure injury, allowing for it to progress to a wound greater than a stage II. This possesses an immediate health and safety risk to the resident in care.
8
9
10
11
12
13
14
Type A
06/09/2022
Section Cited
CCR
87465(a)(1)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange or
1
2
3
4
5
6
7
This poses as an immediate health and safety risk to the resident in care.
8
9
10
11
12
13
14
assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement has not been met as evidenced by the licensee failing to replace the resident’s home health services after her contract with her previous home health agency had expired. Contiinue }
8
9
10
11
12
13
14
As POC, licensee will review this section with their staff and certify that they have read and understood regulation. As proof of POC, the licensee will submit signed documentation that they have reviewed and understand this section of the regulation. POC is due by 6/16/22.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3