374603761-4-30-2021-08-AS-IESA-C2LAAX-20210501000353

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603761
Report Date: 04/29/2021
Date Signed: 04/30/2021 03:19:36 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/24/2019 and conducted by Evaluator James G Santos

COMPLAINT CONTROL NUMBER: 08-AS-20190924101713

FACILITY NAME:	P & P HOMES INC		FACILITY NUMBER:	374603761
ADMINISTRATOR:	ORDINANZA, PAULO C		FACILITY TYPE:	740
ADDRESS:	146 WEDGEWOOD DRIVE		TELEPHONE:	(619) 292-3640
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92114
CAPACITY:	6	CENSUS: 5	DATE:	04/29/2021
		UNANNOUNCED	TIME BEGAN:	02:41 PM
MET WITH:	Paulo Ordinanza		TIME COMPLETED:	03:08 PM

ALLEGATION(S):

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Lack of supervision/Neglect resulting in resident sustaining multiple fractures while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), James Santos contacted Administrator, Paulo Ordinanza via video conference to deliver investigation findings on the above complaint allegation. Due to COVID-19, a tele-visit was conducted. LPA identified himself and discussed the purpose of the call.

Community Care Licensing Department (CCLD) conducted the complaint investigation involving a resident (R1) [See LIC811 Confidential Names List] which consisted of review of R1's facility and medical records, interviews of facility staff, responsible party and outside sources.

On 9/19/2019, it was observed that R1's right knee was swollen after R1 had a birthday celebration at the facility on the same day. Prior to the birthday celebration that day, R1’s knee was not observed to be swollen while being assisted by staff. Medical records showed R1 sustained multiple right knee fractures.

Continued on page 2

THIS IS AN AMENDED REPORT FOR TELE-VISIT DATE, 4/29/2021.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2021

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 08-AS-20190924101713

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: P & P HOMES INC	FACILITY NUMBER: 374603761
	VISIT DATE: 04/29/2021

NARRATIVE

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Per review of R1's facility records, R1 is bedridden and needs total assistance. R1 spends most of the time in the bedroom but does participate in some activities while sitting in the wheelchair.

Based on the interviews with facility staff, they were unable to provide an explanation as to when and how R1 sustained the injury. There are no reports of falls. Staff observed that R1 was sitting in the wheelchair during the party.

Based on the interviews with the facility visiting physician and ER doctor, the injury could have occurred when staff were transferring R1 from the bed into the wheelchair. It was also noted that R1 has osteoporosis in which the bones become fragile and can incur an injury from any slight movement.

The Department has investigated this complaint in regards with the above allegation.

Based on the interviews and review of records, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the above allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited. Exit interview conducted.

A copy of this report along with the Licensee Appeal Rights (LIC 9098, 01/16) form were provided to Administrator, Paulo Ordinanza via electronic mail. An electronic read receipt confirmation was requested to be sent by Administrator upon receipt of the documents.

THIS IS AN AMENDED REPORT FOR TELE-VISIT DATE, 4/29/2021.

SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2021

LIC9099 (FAS) - (06/04)

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