Complaint Investigation Report, 10/18/2021 — Elwyn NC

198601809-10-18-2021-29-AS-JAPL-C82PY9-20211022114335

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD. #250

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

10/14/2021 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20211014150233

Failure to follow the Plan of Operation regarding staffing hours

Licensing Program Analyst (LPA) Ashley Smith conducted an unannounced visit for the above allegation. The LPA spoke with Administrator Samantha Toder over the phone and explained the reason for the visit. Today, the LPA interviewed staff at 9:03 a.m., 9:05 a.m and 9:45 a.m., and reviewed records at 9:29 a.m.

Regarding the allegation, it was alleged that this facility experienced a deficiency of staffing hours from 8/30/2021 – 09/05/2021 and from 09/06/2021 – 09/12/2021, as there needs to be a registered nurse on duty a minimum of eight hours per week per client. During those week(s), there were 5 clients in the home, which required a total of 40 hours. Interviews and documentation review confirmed that the required hours were deficient approximately 20 hours from 8/30/2021 – 09/05/2021 and approximately 14 hours from 09/06/2021 – 09/12/2021. The Administrator confirmed there was a staffing shortage and have since implemented a plan to ensure sufficient hours. Based on the information obtained, this allegation is deemed Substantiated at this time. Per the California Code of Regulations (CCR), Title 22, the following deficiencies were observed and cited: (Refer to LIC 9099-D). Exit interview conducted. A copy of the report was provided.