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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197600430
Report Date: 03/24/2022
Date Signed: 03/28/2022 02:11:25 PM



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
12/15/2020 and conducted by Evaluator Teresa Camara
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20201215170320
FACILITY NAME:VALLEY VIEW RETIREMENT CENTERFACILITY NUMBER:
197600430
ADMINISTRATOR:JUDITH MONTOYAFACILITY TYPE:
740
ADDRESS:7720 WOODMAN AVE.TELEPHONE:
(818) 997-6756
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:116CENSUS: 73DATE:
03/24/2022
UNANNOUNCEDTIME BEGAN:
11:04 AM
MET WITH:Judith MuroTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Questionable Death
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint visit on 03/24/2022 to deliver findings for the above allegation. The initial visit was conducted on 12/16/2020 by LPA Eva Miller telephonically via a video chat and subsequent visits were conducted on 03/04/2022 and 03/11/2022 by LPA Camara. During today’s visit, the LPA met with the facility administrator, Judith Muro and explained the reason for the visit.

On 12/15/2020, the Department received a complaint regarding the allegation Resident #1 (R1) suffered a questionable death while in care.


(continued on 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
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 3
Control Number 29-AS-20201215170320
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: 03/24/2022
NARRATIVE
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On 12/16/2020, between 11:00 a.m. and 11:45 a.m., LPA Miller conducted the initial complaint visit. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the complaint investigation was conducted telephonically. LPA conducted an interview and physical plant tour via video chat with facility administrator Judith Muro. LPA requested copies of pertinent documents relevant to the investigation and noted further investigation would be required.

During LPA Camara’s visit to the facility on 03/04/2022 between 9:47 a.m. and 11:47 a.m., LPA interviewed the administrator at 9:47 a.m., staff 1 at 10:42 a.m. and staff 2 at 10:46 a.m. LPA obtained pertinent documents and conducted a brief facility tour at 11:18 a.m. LPA also conducted a telephonic interview with staff 3 at 3:33 p.m.

During LPA Camara’s visit to the facility on 03/11/2022 between 11:35 a.m. and 12:28 p.m., LPA interviewed staff 4 at 11:07 a.m. and staff 5 at 12:15 p.m. as well as obtained more documents. LPA also conducted a collateral visit with R1’s physician on 03/11/2022 between 1:00 p.m. and 2:18 p.m.

The administrator and staff stated that other than going to the dining room for meals, R1 stayed inside their single occupancy room. R1’s room was equipped with a television which R1 enjoyed watching and R1’s family sent care packages of snack foods which R1 also enjoyed. R1 was friendly but did not have any close friends at the facility. R1 only had one family member who would occasionally visit. R1 did not require assistance with activities of daily living. R1 did receive medication management. Staff stated that since R1 was mostly independent, when they would check on R1 they would knock on the door for permission to enter R1’s room.

Staff stated R1 was last seen at approximately 5:00 p.m. on 12/09/2020, watching television in R1’s room. R1 said goodbye to the staff who checked in as they were leaving for the day. Staff observed R1 was lying in bed watching television; R1 had no complaints. Other staff indicated R1 never complained about not feeling well or anything else; R1 was a very pleasant person. On 12/10/2020, at approximately 08:00 a.m. staff were concerned because R1 had not come to the dining room for breakfast which was very unusual. Staff knocked on R1’s door and when there was no answer, they used a key to unlock R1’s door. It appeared R1 had been sitting on the side of the bed as R1 was found fully clothed and laying across the bed, deceased.

Information gathered reflected R1 was initially admitted to the facility on 08/28/2017 from another assisted living facility. R1’s physician’s report used for admission was from a physician in Hudson, New York dated

(continued on 9099-C)

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20201215170320
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: 03/24/2022
NARRATIVE
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03/23/2015. Physicians’ reports in the facility records for R1 were dated as follows: 09/17/2018, 10/09/2019, and 10/07/2020 all completed by R1’s primary treating physician. R1’s physician also examined R1 on the following dates: 10/04/2019, 06/12/2020, 07/16/2020, 10/11/2020 and 11/02/2020. According to R1’s physician, R1 visited his office on 10/04/2019, the other visits occurred at the facility. During the 10/04/2019 visit an electrocardiogram (ECG) was performed as well as a blood draw for lab work. The ECG showed R1 had suffered two prior heart attacks: one significant and one minor. R1 had no recollection of suffering previous cardiac events. R1’s physician stated R1’s lab results showed R1 appeared to be diabetic. R1’s physician explained it is not unusual for a person with diabetes to not feel chest pain; it is known as a silent heart attack. R1’s physician encouraged R1 to eat healthier and exercise. R1 was told to return to the physician’s office after fasting so more blood work could be obtained, and the physician could determine what type of diabetes medications to prescribe. However, R1 never followed through with getting fasting blood work done. R1’s physician stated R1 was capable of following up on medical appointments. R1’s physician was unaware of R1 having any family involved in her medical care. R1’s physician stated the lack of blood work did not cause R1’s death. R1 was taking two blood pressure medications.

Staff who handle making medical appointments did not recall any requests from R1’s physician for fasting blood work. R1’s physician sees several residents who reside at the facility and has an office in a small room on the first floor of the facility. If the physician wants staff to follow up on something like appointments for blood work, the physician notifies one of the medication technicians. However, some of the physician’s patients handle their own follow up medical care needs.

During the time surrounding R1’s death, the facility had an outbreak of COVID-19. R1 had a PCR test done on 12/06/2020 and tested negative for COVID-19.

The death certificate indicated the immediate cause of death was acute myocardial infarction with underlying causes listed as hypertensive arteriosclerotic heart disease, diabetes mellitus, hyperlipidemia, and obesity.

Based on the medical records, staff interviews and an interview with R1’s physician, it does not appear that lack of following through with blood work led to R1’s death. There is insufficient evidence to confirm that R1’s death was due to facility staff neglect; therefore, this allegation is deemed Unsubstantiated at this time. Exit interview conducted and a copy of the report issued.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3