197600430-1-3-2022-29-AS-DPEA-CBR2MY-20220217163155

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197600430
Report Date: 01/03/2022
Date Signed: 01/03/2022 10:20:42 AM

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
09/28/2020 and conducted by Evaluator Martha Guzman-Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20200928134359

FACILITY NAME:	VALLEY VIEW RETIREMENT CENTER		FACILITY NUMBER:	197600430
ADMINISTRATOR:	GLORIA PADILLA		FACILITY TYPE:	740
ADDRESS:	7720 WOODMAN AVE.		TELEPHONE:	(818) 997-6756
CITY:	PANORAMA CITY	STATE: CA	ZIP CODE:	91402
CAPACITY:	116	CENSUS: 73	DATE:	01/03/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Rosalba Monarrez		TIME COMPLETED:	10:18 AM

ALLEGATION(S):

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Staff do not administer resident's medication as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Martha Guzman Chavez conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegation. The initial visit was conducted on 10/08/2020 by LPA D. Perera and a subsequent visit was conducted on 10/12/2021 by LPA’s Martha Guzman Chavez and KaSandra Lopez. On today’s visit, LPA Guzman Chavez met with Med-Tech Rosalba Monarrez. Entrance interview conducted.

During the initial visit on 10/08/2020, LPA D. Perera conducted a telephonic interview with Administrator, Judith Muro at 10:16 a.m. and obtained copies of pertinent documents. On 10/12/2021, LPA’s Guzman Chavez and Lopez conducted a physical plant tour with Administrator at 11:26 a.m. and conducted a file review of resident files between 10:45 a.m. and 11:25 a.m. Additionally, LPA’s interviewed Med-Tech at 12:10 p.m. and audited medications and centrally stored for three random residents between 12:19 p.m. and 12:48 p.m.
Continued on LIC 9099...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Guzman-Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022

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-20200928134359

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: VALLEY VIEW RETIREMENT CENTER	FACILITY NUMBER: 197600430
	VISIT DATE: 01/03/2022

NARRATIVE

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Conitnued from LIC 9099...

It was alleged that staff do not administer resident's medication as prescribed. It was reported that Resident #1 (R1) medications had not been administered to them during the evening hours as prescribed. Furthermore, review of Medication Administration Record (MAR) by an outside nurse was observed to be mostly blank except for a couple initials to indicate medications were administered during September 2020 and on occasion in which the client refused his medication.

Interview with the administrator revealed that the facility uses both the MAR and centrally stored to keep track of their medication. Administrator stated that pharmacy audits are conducted every six months and they check random samples of residents. According to administrator, R1 had no issues with their medication. If at any time, a resident was not able to pay for their medications, the facility paid. Furthermore, LPA obtained a statement from R1’s former pharmacy which stated, “they never withheld delivery of medications for patients for any reason such as facility not paying for copays because it is not the facility’s responsibility to pay. We also have a policy of trying all means to work with patients to set up payment plans for patients that cannot afford copays or to see if they are eligible for forgiveness.” During the medications and centrally stored audit, LPA’s observed the centrally stored to be complete. The centrally stored for September 2020 had medication Albuterol 90 mcg, to be taken by mouth four (4) times a day as needed; however, medication was self-administered by R1. At that point, R1 had the ability to request for those PRN when needed and staff would administer it. In fact, the centrally stored had refusals for certain medications, the nurse’s notes tracked the refusal for those specific times as well stating contact with residents’ doctor regarding medication refusal. Based on record review, the allegation of “Staff do not administer resident's medication as prescribed.” is deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. A copy of report provided via email.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Guzman-Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022

LIC9099 (FAS) - (06/04)

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