195850240-9-29-2023-29-AS-KLOZ-CW63AT-20230929180515

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850240
Report Date: 08/22/2023
Date Signed: 09/29/2023 12:11:19 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
08/18/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20230818145123

FACILITY NAME:	VARIEL OF WOODLAND HILLS, THE		FACILITY NUMBER:	195850240
ADMINISTRATOR:	JOYCE AQUINO		FACILITY TYPE:	740
ADDRESS:	6233 VARIEL AVE		TELEPHONE:	(818) 651-6018
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	436	CENSUS: 280	DATE:	08/22/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Joyce Aquino		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff mishandled residents’ medication.
Staff did not administer medication as prescribed.

INVESTIGATION FINDINGS:

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This is an amended report. The findings have been changed from Unfounded to Unsubstantiated due to the possibility that the allegations are related to a similar incident which was self-reported through an Incident Report dated 02/13/2023. Although, the data search on 05/24/2023 did not yield the medication stated by the reporting party as being the wrong medication, and the medication was not part of the list of medications being administered by staff at the time of the investigation, it could possibly have been discontinued by the time this investigation took place. The LPA met with the Director Joyce Aquino and explained the reason for the visit.
Licensing Program Analyst (LPA) Sandra Urena conducted an initial complaint visit to investigate the allegations listed above. The LPA met with the Director Joyce Aquino and explained the reason for the visit.
LPA Urena Interviewed the director from 10:45 a.m. to 12:00 p.m. and conducted record review from 12:05 p.m. to 12:35 pm.
Continues on LIC 9099 C...

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: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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-20230818145123

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: VARIEL OF WOODLAND HILLS, THE	FACILITY NUMBER: 195850240
	VISIT DATE: 08/22/2023

NARRATIVE

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Staff mishandled residents’ medication.
On the allegation that staff mishandled residents’ medication; it is the concern of the reporting party that they were told that facility staff had administered a medication(unknown) that did not belong to the resident (unknown). To investigate the allegation the LPA interviewed the director. The director informed the LPA that the facility had self reported on a similar incident through an Incident Report dated 02/13/2023, however the incorrect medication administered to the eye, was prescribed to the same resident, and the medication was for the ear. The incident was resolved as Substantiated on 05/23/2023 and cleared as of 05/25/2023. The LPA could not interview residents or reporting party due to the fact that the complaint did not provide names.

Based on the information obtained through record review and interview, on the allegation that staff mishandled the resident’s medication, the allegation is deemed Unsubstantiated at this time.

Staff did not administer medication as prescribed.

On the allegation that Staff did not administer medication as prescribed; it is the concern of the reporting party that they were told that facility staff had administered the wrong medication (ear drops) to a resident (unknown). To investigate the allegation the LPA reviewed the facility’s medication data and searched for ear drops (Otic agents), conducted along with the facility’s director. The data search did not yield the medication stated by the reporting party as being the wrong medication. The medication is not part of the list of medications being administered by staff to residents. The director informed the LPA that the facility had self reported on a similar incident through an Incident Report dated 02/13/2023, however the incorrect medication administered were not ear drops. The incident was resolved as Substantiated on 05/23/2023 and cleared as of 05/25/2023. The LPA could not interview residents or reporting party due to the fact that the complaint did not provide names.

Based on the information obtained through record review and interview, on the allegation that Staff did not administer medication as prescribed, the allegation is deemed Unsubstantiated at this time.

Exit interview 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: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

LIC9099 (FAS) - (06/04)

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