425801823-10-20-2022-29-AS-KBUY-CKN38G-20221028180132

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425801823
Report Date: 10/20/2022
Date Signed: 10/20/2022 03:58:56 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/30/2021 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20211130130904

FACILITY NAME:	AMALIA'S RESIDENCE II		FACILITY NUMBER:	425801823
ADMINISTRATOR:	DEXTER PRICE		FACILITY TYPE:	740
ADDRESS:	1206 KENSINGTON AVENUE		TELEPHONE:	(805) 287-9630
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	6	CENSUS: 6	DATE:	10/20/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Dexter Price, Administrator		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Resident is being over medicated
Staff refuse to allow resident's friend to visit
Staff do not allow resident to visit privately with a friend
Level of care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted a subsequent complaint visit to deliver final findings for this investigation. LPA met with Dexter Price, Administrator/Licensee and explained the purpose of the visit. LPA reviewed documents and interviewed Hospice Nurse on 10/14/2022, R1’s family member on 5/27/2022, and staff on 10/14/2022.

On the allegation: Resident is being over medicated. Reporting party was concerned that the facility was over medicating Resident 1 (R1) due to their behaviors. LPA Olson interviewed staff on 10/14/2022 who stated the facility follows doctors orders and can’t prescribe medications or give the resident extra doses of medications. Staff follow resident’s prescriptions and count medications often. Staff stated R1 had a nurse come twice a week and oversaw R1’s care and would have noticed or said something if they believed the resident was over medicated.
Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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 29-AS-20211130130904

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: AMALIA'S RESIDENCE II	FACILITY NUMBER: 425801823
	VISIT DATE: 10/20/2022

NARRATIVE

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LPA reviewed R1’s centrally stored medication record and observed no missing information. LPA also observed all medications listed were prescribed by a physician, and did not notice any medications that were refilled too soon. LPA conducted a medication audit of a sample of medications at the facility, and observed they were given as prescribed. Based on record review and interviews this allegation is deemed Unsubstantiated at this time.

On the allegations: Staff refuse to allow resident's friend to visit and Staff do not allow resident to visit privately with a friend. It was alleged that a staff forced R1’s visitor to leave after R1 became very upset and refused this visitor to visit on many occasions. LPA interviewed staff who stated R1 had a friend who would refuse to follow COVID-19 protocols and wouldn’t show proof of vaccination, fill out the symptom screening questionnaire, or wear a mask. Staff stated that the visitor was very persistent and they allowed the visitor access to the resident but would be close by to ensure they wore a mask and stayed 6 feet away and wouldn’t touch the resident, per the COVID-19 restrictions at the time. Staff also stated that R1 would get very agitated and start yelling and screaming when only a certain visitor would come, so they would ask that visitor to step out for a few minutes into the living room while they calmed R1 down. LPA attempted to interview the reporting party (RP) for more information about this visitor and the facility restricting visitation, but the RP refused to speak with the LPA. Based on interviews this allegation is deemed Unsubstantiated at this time.

On the allegation: Level of care. It was alleged that Resident 1 (R1) was bed bound and should be in a skilled nursing facility. LPA interviewed staff that stated R1 was non ambulatory and could sit up, turn over and walk. R1 preferred to be in bed all day due to being scared of falling. Staff stated R1 had many falls at their previous facility and would be scared to walk and get up. LPA verified that the facility was fire cleared for 6 non ambulatory and one bedridden resident. Staff stated they were able to meet all of R1’s needs. LPA reviewed R1’s physician’s report and needs and services plan, and observed R1 did not have any needs listed that would be outside of the scope of an RCFE. Based on record review and interviews this allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of report emailed to Administrator/Licensee.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC9099 (FAS) - (06/04)

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