197607670-2-4-2024-11-AS-JHAD-D2FRXU-20240214122519

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607670
Report Date: 01/30/2024
Date Signed: 02/04/2024 08:17:46 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/14/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20231114103014

FACILITY NAME:	A PARADISE ELDERLY HOME		FACILITY NUMBER:	197607670
ADMINISTRATOR:	YOLANDA BERNARDO		FACILITY TYPE:	740
ADDRESS:	178 WEST 231ST STREET		TELEPHONE:	(310) 876-6917
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	5	CENSUS: 2	DATE:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Yolanda Bernardo		TIME COMPLETED:	03:47 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not assist resident with obtaining medical care.
Staff did not ensure that resident's dietary needs were met.
Staff did not monitor resident for change in condition.

INVESTIGATION FINDINGS:

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

On 1/30/24, Licensing program Analyst (LPA) Ernand Dabuet conducted a subsequent complaint investigation visit at this facility. LPA met with Administrator Yolanda Bernando and explained the purpose of the visit is investigate the allegations mentioned above.

Investigation consisted of: Interview with Administrator, staff #1-#3 (S1-S3), residents #1--#4 (R1-R4) and witnesses #1 - #4 (W1-W4). Records reviews of (R1-R4) Emergency Identification, Physician's Report, Medication Admnistration Record, Pre-Placement appraisal, Admission. A reveiw of Resident and Staff Roster, Facility Menu and other pertinent documents associated with this complaint. A tour of the facility was performed.

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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 11-AS-20231114103014

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: A PARADISE ELDERLY HOME	FACILITY NUMBER: 197607670
	VISIT DATE: 01/30/2024

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

INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff did not assist the resident with obtaining medical care.

Allegation #3: Staff did not monitor resident for change in condition.

The details of this complaint alleged that resident #1 (R1) was not assisted with medical care. The complainant reported that facility staff failed to obtain medical care for (R1) when it was required. On 11/06/23, according to the complainant, (R1) was constipated for three to four days and did not dispatch Emergency Medical Services (EMS) for (R1) to be medically assessed at a local hospital. The complainant reported that the facility staff is not cognizant of (R1’s) change in condition.

On 01/30/24 between 9:20 am – 9:45 am, the Department interviewed Administrator #1 (A1) Yolanda Bernardo. (A1) expressed (R1) was admitted on 10/19/23 at the facility and was only under their care for (18) days. (R1) lived in a private home and was cared for by family members before entering A Paradise Elderly Home.

On 11/06/23 (R1) was taken to Kaiser Permanente South Bay Medical Hospital for constipation. (A1) recalled while (R1) was visited by family members on 11/06/23, there was a concern for (R1's) medical attention. (R1) had not had the usual bowel movement for a couple of days. (A1) claimed that (R1) is on pro re nata (PRN) prescription for Miralax for constipation. (A1) asserted since (R1’s) admittance (R1) was having normal bowel movements five to six times daily. In accordance with the Medication Administration Record (dated: November 2023), (R1) was given (1) capful of Miralax mixed with 6oz of water each day between 11/01/23 and 11/06/23. (A1) declared that (R1) continued to have bowel movements from 11/01/23 through 11/06/23, but it was limited to a small amount of three times daily and not the usual five or six times a day. (A1) refuted the allegation the staff did not fail to seek medical treatment for (R1). (A1) argued (R1) was observed daily for vital signs and did not experience general weakness on 11/06/23. (A1) reasoned that (A1) did not contact (EMS) due to (R1) having only a limited amount of bowel activity. (A1) described (R1) was having bowel activity daily and (R1's) stool was normal. (A1) felt that the situation was not life-threatening and thus did not contact (EMS). (A1) stated it was the family member of (R1) who voluntarily called 911 for (EMS) service to transport (R1) to Kaiser Permanente Hospital. (A1) reported the incident on a Special Incident Report LIC 624 (dated: 11/08/23) to Community Care Licensing (CCL) that (R1) was hospitalized with family who ordered transport via (EMS) on 11/06/23.
(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20231114103014

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: A PARADISE ELDERLY HOME	FACILITY NUMBER: 197607670
	VISIT DATE: 01/30/2024

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

(A1) communicated that she received a call from a family member on 11/08/23 while (R1) was still at the hospital under observation that (R1) would not be returning to the facility. (A1) claimed that the facility is cognizant of (R1’s) change of condition and that staff are fully trained. (R1) is being monitored around the clock and (R1’s) vitals are observed daily.

On 01/30/24, between 11:30 am – 12:10 pm, the Department interviewed (3) out (3) staff #1-#3 verified that (R1) was being assisted with medical care accordingly. (S1-S3) affirmed that (R1) was given Miralax daily from 11/01/23 through 11/06/23 when (R1) started to reduce (R1’s) bowel excretion from five to six times daily to only three times daily. (S1-S3) confirmed that (R1) was not taken by (EMS) as (R1) did not perceive a need for immediate medical care and that (R1's) vital status was all normal. (S1-S3) asserted to be aware of (R1’s) current health conditions and is attentive in monitoring for (R1’s) health condition changes.
On 01/30/24, between 9:45 am – 10:50 am, the Department interviewed (3) out (4) residents #2-#4 (R2-R4) who were complimentary of the staff care and supervision. (R2-R4) stated the facility provided proactive care, and staff responded and appropriately attended to residents.
On 01/30/24, between 10:56 am - 12:19 pm, the Department interviewed (3) out of (4) family representatives witness #2 -#4 (W2-W4) verified that the facility staff is functional and engaging family representatives when obtaining medical care for the residents. (W2) stated (R2) no longer needed care and supervision and is now independent and is no longer at this facility. However, if (R2) required care and supervision again, this would be a place (W2) that would consider readmitting (R2) that is how good this place is commented by (W2). In light of the information gathered, the allegations mentioned above are not supported by sufficient evidence.

Allegation #2: Staff did not ensure that resident's dietary needs were met.

It is alleged that facility staff did not ensure that resident #1 (R1) dietary needs were met. The complainant reported that the facility served (R1) high-sodium food which caused (R1’s foot to swell, and was not provided with water to keep (R1) hydrated.

On 01/30/24 between 9:20 am 9:45 am, the Department interviewed Administrator #1 (A1) Yolanda Bernardo. (A1) claimed (R1) was on a special diet “low sodium” according to (R1’s) Physician’s Report (dated: 10/10/23). (A1) was carefully observed for (R1’s) breakfast, lunch, and dinner meals.
(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20231114103014

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: A PARADISE ELDERLY HOME	FACILITY NUMBER: 197607670
	VISIT DATE: 01/30/2024

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

(R1’s) meals consisted of fruits, vegetables, grains, proteins, dairy, and juices according to the facility menu (dated: October 2023 – November 2023). (A1) reported that all residents are entitled to in-between snacks with fruits, pudding, crackers, and liquid refreshments.

On 01/30/24, between 11:30 am – 12:10 pm, the Department interviewed (3) out (3) staff #1-#3 all verified that (R1) was provided with low sodium meals daily. (S1-S3) reported that meals are well-balanced meals with proteins, carbs, fiber, vitamins, and liquids.
On 01/30/24, between 9:45 am – 10:50 am, the Department interviewed (3) out (4) residents #2-#4 (R2-R4) who were satisfied with the meals and were not on any special diet. (R4) claimed the meals are good portions and there’s a variety. (R4) often would have to request salt (R4) preferred the food on the saltier flavor.

On 01/30/24, between 10:56 am - 12:19 pm, the Department interviewed (3) out of (4) family representatives witness #2 -#4 (W2-W4) reported no concern or issues with the meals provided to the residents in care.
On 01/30/24 between 11:20 am 11:30 am, the Department reached out to (R1) by telephone who was not available for an interview due to (R1’s) health condition. Witness #1 (W1) a conservator to (R1) did not want to be interviewed and did not want to release any information regarding these allegations.
The Department reviewed (R1’s) Medication Administration Record (MAR) (date: October 2023 – November 2023). (R1) was prescribed Atenolol (1) tablet daily, Creon (3) capsule daily, and Miralax (1) capful daily. All these medications have side effects for swelling of legs, ankles, and joints, and dehydration (ref: MayoClinic.org). It was verified that all staff had been trained in the safe preparation of food.

A separate investigation was conducted by Carson Sheriff Station on 11/14/23 and 11/5/23 and the investigation revealed no evidence of neglect/elder abuse.

Based on the information provider, an inspection of the facility, observation, interviews, and analysis of records, the Department found no evidence to support the allegations mentioned above.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegations are Unsubstantiated.

An exit interview was conducted with Yolanda Bernardo, and a copy of the report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4