197609011-4-14-2023-31-AS-NGID-CRQMQR-20230511094908

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609011
Report Date: 04/14/2023
Date Signed: 04/14/2023 04:18:53 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
06/18/2020 and conducted by Evaluator Shira Stamps

COMPLAINT CONTROL NUMBER: 31-AS-20200618160904

FACILITY NAME:	STRAWBERRY COTTAGE		FACILITY NUMBER:	197609011
ADMINISTRATOR:	TAYLOR, DAVID JAMES		FACILITY TYPE:	740
ADDRESS:	43732 SENTRY LANE		TELEPHONE:	(661) 266-7995
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	6	CENSUS:	DATE:	04/14/2023
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	David Taylor,		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Staff fail to provide aid with daily living
Staff failed to address resident's change in medical condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shira Stamps conducted an unannounced subsequent complaint visit for the above allegations. Entrance interview conducted with the Administrator. On 9/6/22, LPA collected documents and on 9/16/22 LPA conducted interviews and collection additional documents.

Allegation: Staff fail to provide aid with daily living

It is alleged that resident one (R1) is being neglected and not receiving proper care. It is alleged that R1’s issues with the toes are getting worse and staff do not clean R1’s toes or R1’s seat, and R1 believes that wound care is needed, and that R1 wants to be transferred to a new facility. Based on document review the facility provides basic services to all residents in care, and R1 had an assisted living waiver program service plan. R1 was also receiving hospice services.

CONTINUED...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20200618160904

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: STRAWBERRY COTTAGE	FACILITY NUMBER: 197609011
	VISIT DATE: 04/14/2023

NARRATIVE

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A review of the hospice care notes from 5/05/20-6/25/20 found that hospice documented and provided services to R1, such as bed baths, incontinence needs, transfers with Hoyer lift, education of pressure ulcers and pain medication administration times, and developed plans for repositioning. R1’s refusal of assistance with daily living was also documented on the hospice care notes. On 6/12/20, R1 was discharged from hospice services because they could no longer meet R1’s needs. On 6/16/20, R1 was taken to the hospital for a foot pressure sore that had been treated by hospice care, and after an assessment from the doctor it was recommended that R1 would benefit from a rehab center due to R1’s history of abusing pain medications. Based on document review, it was found that the facility and hospice provided assistance with daily living to R1, and the facility completed the reappraisal in a timely manner, therefore the allegation, “Staff fail to provide aid with daily living” is deemed unsubstantiated.

Allegation: Staff failed to address resident's change in medical condition

It is alleged that R1 was admitted to Hospice Care on 4/06/20, and that R1 is now no longer receiving Hospice Care and R1 was not informed. An incident report received 5/9/20, was reported to Community Care Licensing (CCL) indicated Hospice Care was notified of R1’s fall and hospice was looking into alternative treatments or alternative facility types for R1 due to the increased demand for pain medication. Based on document review, it was found that R1 was discharged and notified by the hospice agency on 6/12/20 that Hospice Care services could no longer meet the needs of R1, and it was recommended by Hospice that R1 go to a different type of facility such as a pain clinic due to R1’s increased demand for pain medications. It was noted that Hospice explained the plan to R1 and R1 verbalized understanding. Based on document review, R1 was properly notified of changes, therefore the allegation, “Staff failed to address resident's change in medical condition,” is deemed unsubstantiated.

Exit interview conducted. Copy of report delivered to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC9099 (FAS) - (06/04)

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