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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197608907
Report Date:
08/02/2022
Date Signed:
08/02/2022 01:16:08 PM
Unsubstantiated
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
07/02/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20210702142639
FACILITY NAME:
COMPASSIONATE ELDERLY CARE MANAGEMENT SYSTEMS, INC
FACILITY NUMBER:
197608907
ADMINISTRATOR:
CELIA T. OYIBU
FACILITY TYPE:
740
ADDRESS:
44161 11TH ST. W
TELEPHONE:
(661) 317-7354
CITY:
LANCASTER
STATE:
CA
ZIP CODE:
93534
CAPACITY:
6
CENSUS:
2
DATE:
08/02/2022
UNANNOUNCED
TIME BEGAN:
10:45 AM
MET WITH:
Charles Oyibu
TIME COMPLETED:
01:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff left resident unsupervised during medical appointment.
Staff provided expired medication to resident.
Staff not meeting resident's medical needs.
Staff provided resident with another resident's prescribed medication.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to finish investigation into the allegations above. LPA met with the administrator and explained the reason for this visit.
Staff left resident unsupervised during medical appointment.
It is alleged that facility left resident #1 (R1) unsupervised during a medical appointment. Initial visit was conducted on 7/9/21. During this visit LPA was unable to interview R1 due to R1 passing away approximately six months ago. LPA interviewed the administrator regarding this allegation from 10:45-11:15 am. LPA reviewed R1's facility file which included R1's physician report and needs and service plan from 11:15-12:15pm. LPA also reviewed copies of R1's hospital record. Information from R1's physician report and needs and service plan indicate R1 was able to leave the facility unassisted and handle their own medications. Interview with facility staff revealed that staff would drive R1 to their medical appointments and but would not go in with R1. Based on the information obtained through interview and documentation this allegation is deemed Unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME
:
Cassandra Harris
LICENSING EVALUATOR NAME
:
Wendell Smith
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/02/2022
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
2
Control Number
31-AS-20210702142639
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:
COMPASSIONATE ELDERLY CARE MANAGEMENT SYSTEMS, INC
FACILITY NUMBER:
197608907
VISIT DATE:
08/02/2022
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
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27
28
29
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31
32
Staff provided expired medication to resident.
It is alleged that when R1 went to their physician appointment that they had an inhaler that was empty and had expired. LPA was unable to interview R1 to them passing away prior to this visit. LPA reviewed R1's facility file which indicated that R1 handled their own medication and did not receive assistance with incidental health and medical care. LPA interviewed the administrator regarding this allegation. Based on the information obtained through record review and interview this allegation is deemed Unsubstantiated at this time.
Staff not meeting resident's needs.
It is alleged that R1's feet were in poor condition and that R1 was not being bathed enough. LPA conducted an interview with the administrator regarding this allegation. LPA also reviewed R1's facility file which included R1's physician report and pre-placement appraisal. LPA also received copies of R1's hospital records. Information from R1's records indicate R1 did not receive any assistance with bathing or grooming. Based on the information obtained through record review this allegation is deemed Unsubstantiated at this time.
Staff provided resident with another resident's prescribed medication.
It is alleged that R1 was provided with R2's medication when they went to a physician's visit. LPA was unable to interview R1 regarding this allegation due to R1 passing away. LPA interviewed R2 regarding this allegation and R2 could not recall anything about it. LPA interviewed the administrator who stated they were not aware of anything like that happening. He stated both of them handled their own medications and there had been issues in the past with residents trying to share medications and that he had been in touch with licensing regarding that issue. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME
:
Cassandra Harris
LICENSING EVALUATOR NAME
:
Wendell Smith
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/02/2022
LIC9099
(FAS) - (06/04)
Page:
2
of
2