Complaint Investigation Report

197609009-2-20-2025-31-AS-EMIR-DF3VLZ-20250324163244

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD., STE. 250

This is an official report of an unannounced visit/investigation of a complaint received in our office on

07/16/2024 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20240716123550

Staff are not providing care to resident(s) as necessary to meet resident(s) needs while in care.

Licensing Program Analyst (LPA) Michael Cava conducted a subsequent visit to the facility to follow up on the above allegation. The initial visit by LPA Cava was made on 07/19/24. LPAs investigation consisted of staff and resident interviews and record review. It was alleged that the facility didn't have a required nurse (LVN/LPT), on shift, on 06/08/24 and 06/14/24. Reports received reveal that Resident 1 (R1), had seizures on those dates. Review of R1's Admission Agreement indicate that R1 will be provided continuous care and supervision. The facility's Program Design further state that there will be a nurse on site twenty-four hours per day "to provide direct care staffing levels that exceed the requirements of a Servicel Level 4I facility, which are consistent with the staffing levels and qualifications upon which this CPP development was approved" As a result of the nurse's absence, staff did not provide the care to R1 as necessary to meet R1's needs when they experienced seizures on 06/08/24 and 06/14/24. Based on further review, the above allegation remains Substantiated. Citation already issued on 07/19/24, and corrections were made on 08/24/24. No further citaitons issued at this time. Administrator advised and a copy of this report issued.