197600430-12-6-2023-29-AS-KHEN-CZY2PV-20240129163459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197600430
Report Date: 12/06/2023
Date Signed: 12/06/2023 03:15:56 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
12/01/2023 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20231201085402

FACILITY NAME:	VALLEY VIEW RETIREMENT CENTER		FACILITY NUMBER:	197600430
ADMINISTRATOR:	JUDITH MONTOYA		FACILITY TYPE:	740
ADDRESS:	7720 WOODMAN AVE.		TELEPHONE:	(818) 997-6756
CITY:	PANORAMA CITY	STATE: CA	ZIP CODE:	91402
CAPACITY:	116	CENSUS: 70	DATE:	12/06/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Judith Montoya Administrator, Rosalba "Rosie" Monarrez, staff		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Facility staff are not ensuring that resident takes their medications while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced 10-day initial complaint visit to this facility. At 9:30 a.m., the LPA met with the Administrator, Judith Montoya and explained the reason for the visit. During the time of the visit, the Administrator left the facility and authorized staff, Rosalba "Rosie" Monarrez to sign the report.

At 9:35 a.m., the LPA conducted an interview with the Administrator. At 9:50 a.m., the LPA reviewed records and obtained copies of pertinent documents. Between 9:44 a.m. and 2:31 p.m., the LPA conducted interviews seven (7) out of seventy (70) residents and two (2) staff. At 2:35 p.m., the LPA along with staff, conducted a physical plant tour. Additionally, on 12/01/2023, the LPA conducted an interview with a resident’s therapist.

Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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-20231201085402

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: VALLEY VIEW RETIREMENT CENTER	FACILITY NUMBER: 197600430
	VISIT DATE: 12/06/2023

NARRATIVE

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Regarding the allegation: Facility staff are not ensuring that resident takes their medications while in care. It was alleged that due to facility staff not properly assisting Resident #1 (R1) with their self-administration of medication, led to R1 not taking their medications. Interview with the Administrator revealed that R1 has been having feeling depressed and R1 disclosed to the Administrator that R1 in the past has spit out R1’s medication instead of ingesting it. The Administrator explained that immediately after hearing R1’s statement, the Administrator informed R1’s responsible person and R1’s primary health clinic. The Administrator stated that she also informed R1’s therapist and R1’s case manager regarding the incident. The Administrator explained that staff dispense R1’s medication and hand it to R1 in a small cup, along with a cup of water and staff stay to supervise R1 until R1 takes their medication. The Administrator stated that staff have not witnessed R1 spit out medication. Interview with Staff #1 (S1) revealed that staff do stay with R1 to supervise R1 take their medication. Interview with R1 did not reveal any concerns regarding staff not properly assisting with R1’s self-administration of R1’s medication. R1 did not voice any concerns regarding staff and stated that staff supervise R1 when taking medication. Additionally, interview with R1’s therapist on 12/01/2023, revealed that the facility staff and Administrator are constantly in contact with R1’s health clinic and psychologist. R1’s therapist stated that facility staff and Administrator have been cooperative and helpful regarding R1’s care and supervision. During the time of the visit, R1, R1’s family member, R1’s therapist, S1 and the Administrator held a meeting regarding R1’s care and current medication, and no additional issues were raised during the meeting. Interviews with multiple residents did not reveal issues regarding staff not properly assisting with residents’ medication. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

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

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

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