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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850240
Report Date: 09/12/2022
Date Signed: 09/12/2022 05:38:00 PM

Substantiated


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
08/26/2022 and conducted by Evaluator Ashley Smith
COMPLAINT CONTROL NUMBER: 29-AS-20220826125755
FACILITY NAME:VARIEL OF WOODLAND HILLS, THEFACILITY NUMBER:
195850240
ADMINISTRATOR:PAYNE, KEITHFACILITY TYPE:
740
ADDRESS:6233 VARIEL AVETELEPHONE:
(818) 651-6018
CITY:WOODLAND HILLSSTATE: ZIP CODE:
91367
CAPACITY:436CENSUS: 89DATE:
09/12/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Keith PayneTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff handled resident inappropriately, resulting in resident sustaining a bruise
Facility did not fulfill reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a subsequent complaint visit. The LPA met with Executive Director Keith Payne and explained the reason for the visit.

During the 8/31/2022 visit, the LPA interviewed twelve (12) staff between 2:00 p.m. - 4:30 p.m. and obtained documents. Today, the LPA interviewed staff at 12:11 p.m., 12:45 p.m., and 1:00 p.m., and interviewed Resident #1 (R1) at 11:33 a.m. The LPA also toured the Wellness Center and reviewed documents.

Regarding the allegation: Staff handled resident inappropriately, resulting in resident sustaining a bruise
It was alleged that Resident #1 (R1) developed bruising on their forearms due to an inappropriate transfer. Interviews with R1 reported that the morning of 8/20/2022, while assisting R1 with care, staff ‘pulled’ R1 up by their wrists. Photos taken 8/20/2022 revealed bruising on both of R1's wrists and forearms. Staff confirmed that pulling R1 – or any resident – by their wrist or forearm to assist or transfer them is inappropriate.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
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 5
Control Number 29-AS-20220826125755
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: 09/12/2022
NARRATIVE
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Rather than pulling a resident by their forearms, staff are instructed to assist with a transfer by placing their arms under R1’s armpits for a gentle assist. R1 claimed that this was the first time this had happened and believed it was accidental. Interviews confirmed that R1 reported this occurrence to staff; however, R1 did not identify the specific staff whom performed the improper transfer.

Additional interviews confirmed that the bruising was reported to Director of Wellness and to the Director of Resident Care Services on 8/20/2022. It was reported that once staff received word of this incident, staff checked in with R1. Whereas it was reported that the facility is unaware as to whom pulled R1 by the arms, there was no additional follow up, investigation, or training conducted with care staff.

Interviews and records review indicated that R1 was prescribed Eliquis, which according to the Mayo Clinic, can make a person more susceptible to bruising as it is a blood thinner. Staff and records review also indicated that R1 had sensitive skin and the facility has documented occurrences when they have noticed increase redness on R1’s body. However, the presence of bruising on 8/20/2022 was in direct correlation of R1 being handled in a manner which resulted in bruising. Based on the information obtained during the course of the investigation, there is sufficient evidence to support the claim that staff handled resident inappropriately, resulting in R1 sustaining bruises. This allegation is deemed Substantiated at this time.

Regarding the allegation: Facility did not fulfill reporting requirements


It was alleged that the facility failed to report the unusual incident to the Department. Interviews and record review confirmed that the bruising was reported to Director of Wellness and to the Director of Resident Care Services on 8/20/2022. In addition, staff also communicated the incident to R1’s responsible party. However after review of internal records, the facility did not submit an Unusual Incident Report to Community Care Licensing documenting the occurrence of the bruising.

Based on the information obtained, there is sufficient evidence to support the claim that the facility did not fulfill reporting requirements. This allegation is deemed Substantiated at this time.

The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20220826125755
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/14/2022
Section Cited
CCR
87468.2(a)(4)
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87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities. Residents shall have all of the following...: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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The Administrator agreed to do the following:
1. Submit a Statement of Understanding, noting the measures staff will take to lower the risk of residents developing bruises. Submit the Plan of Action to CCL by 9/14/2022.
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This requirement is not met as evidenced by:
Based on interview and record review, the licensee did not comply with the section cited above, as R1 was handled in a manner which resulted in R1 sustaining bruises, which poses an immediate health and safety risk to residents in care.
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2. Host an in-service training regarding appropriate transferring methods and working with residents with skin integrity issues. Submit sign-in sheet and any training materials. Training must be done by 9/23/2022.
Type B
09/16/2022
Section Cited
CCR
87211(a)(1)(D)
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87211(a)(1)(D). Reporting Requirements. Each licensee shall furnish to the licensing agency such reports as the Department may require, including: Any incident which threatens the welfare, safety or health of any resident.
This requirement is not met as evidenced by:
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The Administrator agreed to do the following:
1. Submit an unusual incident report regarding the 8/20/2022 occurrence of the bruise. Submit incident report by 9/16/2022.
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Based on observation and interview, the licensee did not comply with the section cited above, as the facility did not submit an unusual incident report regarding, the bruises observed on R1, which poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
08/26/2022 and conducted by Evaluator Ashley Smith
COMPLAINT CONTROL NUMBER: 29-AS-20220826125755

FACILITY NAME:VARIEL OF WOODLAND HILLS, THEFACILITY NUMBER:
195850240
ADMINISTRATOR:PAYNE, KEITHFACILITY TYPE:
740
ADDRESS:6233 VARIEL AVETELEPHONE:
(818) 651-6018
CITY:WOODLAND HILLSSTATE: ZIP CODE:
91367
CAPACITY:436CENSUS: 89DATE:
09/12/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Keith PayneTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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2
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9
Staff are not up to date regarding resident care needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a subsequent complaint visit. The LPA met with Executive Director Keith Payne and explained the reason for the visit.

During the 8/31/2022 visit, the LPA interviewed twelve (12) staff between 2:00 p.m. - 4:30 p.m. and obtained documents. Today, the LPA interviewed staff at 12:11 p.m., 12:45 p.m., and 1:00 p.m., and interviewed Resident #1 (R1) at 11:33 a.m. The LPA also toured the Wellness Center and reviewed documents.

Regarding the allegation: Staff are not up to date regarding resident care needs
It was alleged that residents are being accepted into the community with extensive care needs, yet staff are not made aware of resident care needs. Inconsistent statements were shared regarding the influx of new residents and how staff are acclimated to resident care needs.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20220826125755
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: 09/12/2022
NARRATIVE
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In summary, the majority of staff noted that they become familiar with care needs by discussing resident care needs amongst one another during the overlap shift times, they review care notes in the online system, they can review assessments, and they can also discuss care needs with the resident themselves. It was communicated that the information is available to staff and that it is an expectation that staff become familiar with residents upon move in. It was also communicated that staff are sometimes unaware of new residents until they are assigned to care for them. However, it was noted that information pertaining to new residents is discussed and documented for all staff to review.

It was mentioned that Resident #2 (R2) had extensive care needs that were not communicated or discovered until R2 was admitted to the facility. The LPA audited R2’s file during today’s visit and noted that R2 was admitted on 8/20/2022 yet was assessed on 8/18/2022 and was deemed appropriate. Interviews supported claims that staff have received training on how to safely meet R2’s needs and can employ several resources and methods to obtain additional information about R2, including speaking to the Directors, Nurses, and R2’s family. At this time, staff in general feel that they know how to manage R2’s care. Yet, there were inconsistent statements shared as to whether all staff were aware as to how to properly care for R2 upon admission to the facility, as some staff felt ill-prepared to properly assist R2.

Based on the information obtained, there is insufficient evidence to support the claim that staff are not up to date regarding resident care needs. This allegation is deemed Unsubstantiated at this time.

However, it appears that R2’s appraisal and/or physician’s report may not accurately reflect R2’s current care needs and capabilities. This will be addressed in a case management report.

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

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5