191201867-12-5-2023-29-AS-KLOZ-D28627-20240206192501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191201867
Report Date: 12/05/2023
Date Signed: 12/05/2023 03:52:52 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
11/28/2023 and conducted by Evaluator Elsie Campos

COMPLAINT CONTROL NUMBER: 29-AS-20231128091732

FACILITY NAME:	EISENBERG VLG OF THE LA JEWISH HOME FOR THE AGING		FACILITY NUMBER:	191201867
ADMINISTRATOR:	GLASS, KATHLEEN K.		FACILITY TYPE:	740
ADDRESS:	18855 VICTORY BOULEVARD		TELEPHONE:	(818) 774-3000
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	271	CENSUS: 97	DATE:	12/05/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator-Kathleen Glass		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Due to staff neglect, resident had a reoccurance of scabies

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Elsie Campos arrived to the facility unannounced to conduct an initial 10 day complaint visit for the above allegation. The LPA met with Executive Director Kathleen Glass and Administrative Assistant Allison Tepper and explained the reason for the visit.

The LPA conducted interviews with Executive Director and Staff between 10:00 a.m. and 11:00 a.m. the LPA conducted a physical plant tour at 11:30 a.m. and reviewed documents between approximately 1:45 p.m. and 2:45 p.m.

**Continued on LIC 9099-C**

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Elsie Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 29-AS-20231128091732

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: EISENBERG VLG OF THE LA JEWISH HOME FOR THE AGING	FACILITY NUMBER: 191201867
	VISIT DATE: 12/05/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation: Due to staff neglect, resident had a reoccurrence of scabies.

It was alleged that due to staff neglect Resident had a reoccurrence of scabies. Documentation confirmed that at the suspicion of the rash for Resident #1 (R1) on 8/30/2023, treatment advice and treatment was started. On 9/26/2023 R1’s symptoms persisted. R1 was seen by the dermatologist on 9/29/2023 and treatment was continued. On 9/29/2023, Dermatologist diagnosed R1 with Dermatitis and suspected scabies. R1 was subsequently confirmed to positive to Scabies on 10/20/2023. Resident #2 (R2) presented rash symptoms on 9/29/23 at which time was treated with Elimite (Permethrin) cream, which is used for various skin conditions including scabies, however R2 was not confirmed to be positive for scabies and was prescribed the treatment as a preventative measure. R2 was treated again on 10/17/2023 and 10/19/2023 as symptoms continued. On 11/3/2023 R2 was on continued treatment for skin itching and on 11/9/2023 R2 had reported that symptoms had improved. R2 was not diagnosed with a confirmed case of Scabies. Interviews confirmed that for precautionary reasons, the facility treated twenty-nine (29) residents and one (1) staff with topical cream for presumed scabies exposure as they were exhibiting itchiness and skin rash between the dates of 9/27/2023 and 11/26/2023. Interviews and documentation confirmed that the initial residents who were identified with rashes in September 2023 and October 2023 received prescription medication to treat the rashes. Interviews with the Executive Director and Clinical Manager confirmed that a community-wide clean-up took place and continues to be in effect, which included laundering all the resident clothing and linens, washing the carpets, sanitizing and cleaning all common spaces, replacing mattresses and disposing of furniture suspected of being a source.

When the facility had a confirmed case of scabies, it was reported to the Department and the local health department and staff conducted appropriate cleaning and isolation protocols and took immediate preventative measures. Based on the evidence obtained, there is insufficient evidence to support the claim that the due to staff neglect resident had a reoccurrence of Scabies. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Elsie Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2