Driftwood Healthcare: Consent Given to Wrong Person - CA
The inspection, completed November 25, 2025, was triggered by a complaint. It focused on a single resident, identified in records only as Resident 1, who had been prescribed Quetiapine Fumarate and Aripiprazole, two antipsychotic drugs used to treat conditions including schizophrenia, bipolar disorder, and dementia-related agitation. Before those medications could be administered, someone with legal authority to decide had to agree to them.
The facility went to a family member.
That family member did not have legal authority to make medical decisions for Resident 1. A conservator did. A conservator is a person appointed by a court specifically to make decisions on behalf of someone who cannot make them independently. The conservatorship strips the individual of certain legal rights and grants them to someone else, by judicial order. Whatever the family member's relationship to Resident 1, they were not that person.
The Director of Nursing acknowledged the error directly during an interview with inspectors at 3:02 p.m. on the day of the inspection. The consent for both Quetiapine Fumarate and Aripiprazole, she said, should have been obtained from Resident 1's conservator. The reason it wasn't: staff didn't know the conservator existed.
That's not a paperwork problem. That's a failure to know who is legally responsible for a resident in their care.
A conservatorship is a matter of public record, established through court proceedings. When a facility admits a resident who is under conservatorship, identifying that legal relationship is part of intake. The conservator is the person the facility is supposed to call when a doctor proposes a new medication, when a care plan changes, when something goes wrong. Bypassing that person, even unintentionally, means the person with actual legal authority over those medical decisions was left out entirely.
Driftwood's own policy, titled "Surrogate Decision Maker, Informed Consent" and dated November 14, 2025, states the facility will identify a person unaffiliated with the facility to serve as a representative of the resident, including public guardians. The policy existed. The process it described did not happen.
Inspectors cited the deficiency under F0552, which covers residents' rights to be informed and to make decisions about their care. The level of harm was recorded as minimal harm or potential for actual harm. Few residents were identified as affected.
The minimal harm designation reflects the regulatory floor, not a verdict on what the medications did or did not do to Resident 1. Quetiapine and Aripiprazole are not minor drugs. Quetiapine carries a black-box warning for elderly patients with dementia-related psychosis, the most serious caution the FDA issues, noting an increased risk of death. Aripiprazole carries the same warning. Whether Resident 1 has dementia is not stated in the inspection report. What is stated is that someone received these drugs after a consent process that excluded the one person legally empowered to consent to them.
The facility's plan of correction was not included in the inspection document. Readers seeking that information were directed to contact Driftwood Healthcare Center or the state survey agency directly.
What the record shows is a gap between what the facility's own written policy required and what actually happened to Resident 1. The Director of Nursing did not dispute it. The explanation offered was simple: staff were not aware the conservator existed.
Resident 1 got the medications either way.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Driftwood Healthcare Center from 2025-11-25 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: August 23, 2026 · Our methodology
DRIFTWOOD HEALTHCARE CENTER in TORRANCE, CA was cited for violations during a health inspection on November 25, 2025.
The inspection, completed November 25, 2025, was triggered by a complaint.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.