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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300600977
Report Date: 08/23/2024
Date Signed: 08/23/2024 04:57:52 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/13/2024 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240813150102
FACILITY NAME:TOWN & COUNTRYFACILITY NUMBER:
300600977
ADMINISTRATOR:STEPHANIE JUKICFACILITY TYPE:
741
ADDRESS:555 E. MEMORY LANETELEPHONE:
(714) 547-7581
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:328CENSUS: 110DATE:
08/23/2024
UNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Nikka Solomon, Assisted Living CoordinatorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Due to lack of staff, colostomy care was provided by unqualified staff
Due to lack of staff, residents did not receive their medications on time
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced inspection visit to deliver findings for complaint investigation into the above allegations. LPA explained the reason for the visit with Assisted Living Coordinator Nikka Solomon.
During the course of the investigation LPA toured facility, reviewed records, conducted interviews with staff & residents, and requested pertinent documentation such as Resident records, Resident rosters, staff rosters, Medication Administration Records, and Course Completion History.

During investigation LPA conducted interviews with staff. Staff interviews revealed that one resident in facility required colostomy care. Staff interviews with six of twelve staff confirm that staff that assist with colostomy care residents require assisted hands on training for three weeks before assisting care independently. Staff interviews confirmed that not all staff receive this training only Medical Technicians, Nurses and Lead Caregivers.
CONTINUED ON 9099C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
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 2
Control Number 22-AS-20240813150102
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: TOWN & COUNTRY
FACILITY NUMBER: 300600977
VISIT DATE: 08/23/2024
NARRATIVE
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Interviews conducted with residents revealed that eight of eight residents confirmed that residents do not have issues with staff and facility has adequate staff on the floor. Eight of eight residents confirmed that they do not have issues with medication and confirm that they receive medications in timely scheduled manner. Eight of eight residents confirm that staff are available to them when needing assistance. Interview with Resident 1 (R1) confirmed that R1 requires assistance with changing Colostomy bag. R1 stated that all staff that have provided assistance with Colostomy bag change out bag every five days. R1 confirms that staff are well trained when changing bag and R1 confirmed they have not had any issues with staff who provide colostomy care. R1's Physician's report confirms Colostomy care assistance is required.

Medication Administration Records reviewed for eight residents, revealed that residents are receiving medications prescribed. Records indicate when resident medications were discontinued and if resident refused medications.


Based on interviews conducted and records reviewed, this agency has investigated the complaint alleging Due to lack of staff, colostomy care was provided by unqualified staff and residents did not receive their medications on time. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/ or is without reasonable basis.


An exit interview was conducted with facility representative and a copy of this report was reviewed and provided at the time of this visit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2