195850239-7-9-2024-29-AS-KLOZ-D7P4CJ-20240730185914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850239
Report Date: 07/09/2024
Date Signed: 07/09/2024 02:50:14 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
03/13/2024 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20240313111140

FACILITY NAME:	SILVER LIGHT CARE		FACILITY NUMBER:	195850239
ADMINISTRATOR:	KHACHATRYAN, ELBA		FACILITY TYPE:	740
ADDRESS:	8201 VANTAGE AVENUE		TELEPHONE:	(747) 228-4111
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	6	CENSUS:	DATE:	07/09/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Elba Khachatryan		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility retained resident with a higher level of care needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a subsequent visit to investigate the allegation listed above. The LPA was greeted by staff and informed them of the reason for the visit. Staff contacted Administrator on the phone and LPA explained the reason for the visit, and the LPA read the report over the phone. Administrator was unable to come to the facility and allowed staff to sign off on the report.
On 03/20/2024, Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct an initial 10-day visit to investigate the allegation listed above. The LPA was greeted by staff and informed them of the reason for the visit. Staff contacted Administrator on the phone and LPA explained the reason for the visit. Administrator stated that they would arrive shortly. The Administrator arrived at 11:35 a.m. The LPA interviewed the staff at 11:08 a.m. and the administrator at 11:45 a.m. Additionally, the LPA requested the documents pertaining to the allegation.
Continues on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

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-20240313111140

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SILVER LIGHT CARE	FACILITY NUMBER: 195850239
	VISIT DATE: 07/09/2024

NARRATIVE

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On the allegation that the ‘facility retained a resident with a higher level of care needs’, it is the concern of the complainant that the resident 1 (R1) has become too ill to be in this facility. The R1 was found to be experiencing shortness of breath and no oxygen was available in the facility. The LPA conducted record review, and R1’s physician report dated 01/16/2024, states that R1’s primary diagnosis is neuropathy, sciatica, dermatitis, and muscle weakness, and secondary diagnosis as anxiety. Furthermore, record review of medical records from a rehabilitation center dated 12/13/2023, also state that the primary diagnosis is neuropathy, sciatica, and muscle weakness. No records were found with diagnosis of breathing problems or the need to use oxygen. On 07/09/2024, LPA Urena interviewed R1 from 12:15 p.m. to 1:17 p.m. The interview revealed that on 03/03/2024, R1 was experiencing shortness of breath while in the bathroom. The R1 called the staff to assist them and to tell them that they could not breathe. The staff asked if R1 wanted them to call 911 and the R1 stated, ‘Yes’. Emergency Medical Team personnel arrived and transported R1 to the hospital where physicians found clots in R1’s lungs and diagnosed it as pulmonary embolism without acute pulmonale. The R1 stated that they were not aware that they had clots. When asked if their primary doctor had order oxygen for their use, R1 denied ever having the need to use oxygen.

Although, R1’s level of care became higher at the time of the hospitalization, the facility was not aware nor noticed any changes in the level of care for R1 before the incident took place on 03/03/2024. The facility followed protocol to assist the R1 in the time of critical need and was able to get help in a timely manner. Therefore, the allegation that the facility retained resident with a higher level of care needs, is deemed Unsubstantiated at this time.

Exit interview was conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

LIC9099 (FAS) - (06/04)

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