198602377-7-31-2022-11-AS-SCIS-CM6SPQ-20221216130331

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602377
Report Date: 07/29/2022
Date Signed: 07/31/2022 05:26:09 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/18/2022 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20220718162632

FACILITY NAME:	FAMILY CONNECT MEMORY CARE INC		FACILITY NUMBER:	198602377
ADMINISTRATOR:	SPIGLANIN, LAUREN MAHAKIAN		FACILITY TYPE:	740
ADDRESS:	1747 GREENWOOD AVENUE		TELEPHONE:	(310) 383-1877
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	6	CENSUS: 5	DATE:	07/29/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Mary Lou Giebel/Rosselyn Fagaragan		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff are not adequately supervising residents in care.

INVESTIGATION FINDINGS:

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On 7/29/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted a subsequent unannounced complaint visit at this facility. Upon arrival, LPA called the facility to conduct a risk assessment. LPA spoke with Licensee Lauren Spiglanin, who confirmed the facility is Covid-19 free. LPA met with Director of Care Mary Lou Giebel and Facility Nurse Rosselyn Fagaragan who assisted LPA with the visit. LPA explained the purpose of the visit.

The investigation consisted of the following: LPA toured the inside and outside grounds of the facility with the facility nurses. LPA requested and obtained copies of Staff Roster, Resident Roster, Residents' R(#1-R#2) service records. LPA interviewed the licensee/administrator and five (5) staff. LPA's attempt to interview all five residents was unsuccessful.

Report continued in LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

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 11-AS-20220718162632

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: FAMILY CONNECT MEMORY CARE INC	FACILITY NUMBER: 198602377
	VISIT DATE: 07/29/2022

NARRATIVE

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Investigations revealed:

Allegation: Facility staff are not adequately supervising residents in care.

It is alleged that Facility staff are not adequately supervising residents in care. The Reporting Party (RP) alleged a male individual screams loudly asking for help during mornings and evenings. RP added during the pre-investigation interview that another individual also screams and yells out for help. The department reviewed Residents' (R#1 and R#2) service records. Appraisal/Needs and Services Plan show R#1 speaks loudly, and he has behavior episodes of screaming, physically aggressive during Activities of Daily Living (ADL) care and verbally aggressive. A care staff closely monitors his behaviors and constantly supervises his needs. A care staff provides therapeutic communication and redirection as necessary. In addition, a 24-hour facility nurse is available. A death report shows R#2 passed away on 7/25/2022. Prior to passing, R#2 was taking medications for agitation and pain management as shown on the Physician Orders. LPA observed several medication adjustments on file. The department interviewed the licensee/administrator (S#1), two (2) facility nurses (S#2 and S#3), Activity Director (S#4) and two (2) care staff (S#5 and S#6). Based on the interviews conducted, S#1-S#6 revealed R#1 has behavior episodes of screaming and yelling and R#2 grimaces, yells and cries during ADL care. S#1-S#6 stated R#1 and R#2 cannot communicate properly due to their medical conditions; staff closely monitor their behaviors, and redirect them as necessary; their families are aware of their conditions; their primary physicians are constantly informed of their behaviors; different medications and medication adjustments were prescribed by their physicians. S#1 revealed she received a complaint from a neighbor and she has been responsive to the neighbor's concern. S#1 stated the facility provides a staffing ratio of 1 (one) care staff for two residents and LPA observed during the visits that this staffing ratio is followed and maintained. In addition to the care staff, there is at least one nurse on site and an Activity Director who also provide direct care to residents. Based on observations, record reviews and interviews, there is no sufficient evidence to corroborate the allegation above.

Based on information gathered, LPA did not find sufficient evidence to support allegation "Facility staff are not adequately supervising residents in care."

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

An exit interview was conducted with Director of Care Mary Lou Giebel, and a copy of the LIC 9099 report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

LIC9099 (FAS) - (06/04)

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