197609534-8-20-2024-31-AS-EMIR-D8ZV7Y-20240911161156

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609534
Report Date: 08/20/2024
Date Signed: 08/20/2024 02:48:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
01/11/2024 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20240111145340

FACILITY NAME:	AZALEA GARDENS		FACILITY NUMBER:	197609534
ADMINISTRATOR:	ABDELKADER,FOOREVER C.		FACILITY TYPE:	740
ADDRESS:	6231 AZALEA DRIVE		TELEPHONE:	(661) 422-6160
CITY:	QUARTZ HILL	STATE: CA	ZIP CODE:	93536
CAPACITY:	6	CENSUS: 2	DATE:	08/20/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Khristine Campbell (administrator designee)		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident sustained multiple pressure injuries and developed clots in their lungs due to staff neglect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Evelin Rios conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegation. LPA met Khristine Campbell the administrator designee and explained the reason for the visit. It was reported that Resident#1(R1) developed blood clots in their lungs as well as pressure injuries on their ears and buttocks, as a result of facility neglect.

The initial visit was made by LPA Rios on 1/17/24 At 1:20 p.m., LPA conducted a physical plant tour, reviewed facility files, and obtained copies of facility’s personnel report, register of facility residents, visitor log, R1’s identification and emergency information, progress notes, physician’s report, preplacement appraisal, resident appraisal, appraisal/needs and services plan, and an unusual incident report. The complaint was referred to Investigations Branch (IB) on 1/17/24, and accepted as a full investigation, assigned to Investigator Juan Lozano and reassigned to Investigator Douglas Real on 3/7/24. During the course of the investigation, IB Investigator Real interviewed the facility Administrator, staff, residents, and hospital staff. Investigator also obtained and reviewed R1’s hospital records. (Continue to LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

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-20240111145340

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AZALEA GARDENS	FACILITY NUMBER: 197609534
	VISIT DATE: 08/20/2024

NARRATIVE

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(Continued from LIC9099)

Regarding the allegation that facility employees neglected or failed to provide an appropriate level of supervision which resulted in Resident#1(R1) developing blood clots in their lungs as well as pressure injuries on their ears and buttocks, IB Investigator Real interviews revealed the facility residents had no complaints and a family member of one resident interviewed reported being happy with the level of care being provided by the facility. The facility employees denied the allegation. R1 left the facility on 1/5/24 and was seen in the hospital on 1/6/2024 with no marks or injuries identified. R1 was diagnosed with pneumonia and no abuse or neglect concerns were noted in the records. On 1/7/2024, R1 was readmitted to the hospital and diagnosed with blood clots in their lungs and a UTI. On 1/8/2024, R1 was transferred to another hospital for further treatment and it was reported that R1’s family member spoke with R1’s hospital doctor and reported abuse concerns alleging that R1 was never moved and left in bed at all times. The doctor concluded that R1’s immobility (as reported by R1’s family member) most likely led to the blood clots in their lungs. R1’s family member was interviewed and did not recall telling anyone R1 was not moved and in bed at all times while they were residing at the Azalea Gardens facility. R1’s hospital doctor was interviewed and could not definitively identify the cause of the R1’s blood clots. The doctor also advised R1 had no pressure injuries on their ears or buttocks, but R1 had a blister on their buttocks and a small bilateral bruise on each ear of unknown cause. The information and evidence obtained did not sufficiently support the allegation, thus based on the information obtained and the interviews conducted the allegation is deemed Unsubstantiated.

Exit Interview Conducted. A copy of this report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

LIC9099 (FAS) - (06/04)

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