197600430-3-29-2022-29-AS-JAPL-CDDQ69-20220411115308

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197600430
Report Date: 03/29/2022
Date Signed: 03/29/2022 03:24:14 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
08/20/2020 and conducted by Evaluator Salia Walker

COMPLAINT CONTROL NUMBER: 29-AS-20200820143226

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:	03/29/2022
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Judith Montoya, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Failure to provide required Basic Services

Failure to maintain facility clean, safe and sanitary

Failure to meet residents needs for restricted health care conditions

Failure to ensure compliance with personnel requirements

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint visit. The purpose of the visit is to deliver the findings for an investigation initiated by LPA Eva Miller on 08/24/2020. The LPA met with Administrator Judith Montoya at 9:35 a.m., and explained the reason for the visit.

On 08/24/2020, LPA Eva Miller initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the complaint investigation was conducted virtually with the use of "FaceTime" with Administrators Gloria Padilla (A-1) & Judy Montoya (A-2). Interviews were conducted with the Administrator(s), and Staff #1 (S-1). A tour of the room assigned to Resident #1 (R-1) was conducted at 3:15pm. LPA Miller requested copies of pertinent facility files and documents. The LPA determined, at that time, that further investigation was required.
Continue on LIC 9099C..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

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-20200820143226

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: 03/29/2022

NARRATIVE

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During today’s visit, the LPA conducted a physical plant tour with the administrator at 10:45 a.m., to ensure there are no health and safety hazards. From 9:06 a.m. until 9:30 a.m., the LPA conducted an interview with S1. From 9:35 a.m. until 10:45 a.m., the LPA conducted an interview the administrator; reviewed and obtained additional copies of documents pertinent to the investigation. From 10:56 a.m. until 11:07 a.m., the LPA conducted an interview with Resident #2 (R2). From 12:03 p.m. until 12:22 p.m., the LPA conducted a telephone interview with R1’s family member.

Regarding the allegation, ‘Failure to provide required Basic Services,’ the complainant’s concern is that the facility is not providing Resident #1 (R1) with basic services as R1 was allegedly physically unclean at the time of visit on 08/18/2020.

During the investigation, the LPA conducted interviews with S1, the administrator, R2, and R1’s family member. Interviews with S1, and the administrator revealed that residents are assisted with basic service needs such as bathing, grooming, and toileting on a ‘daily basis.’ Interview with R2 revealed, that that they would observe R1 showered ‘at least every other day,’ and was assisted in being ‘changed every day between 9:00 a.m. and 10:00 a.m.' Interview with R1’s family member revealed, that they would visit R1 at the facility about three (3) times a week. Interview with R1’s family member also revealed, that R1 appeared well groomed during visits, and confirmed staff would assist R1 with basic service needs.

Based on interviews with the administrator, staff, R2, and R1’s family members, facility staff did assist R1 with basic services such as bathing, grooming, and toileting. Therefore, there is insufficient evidence to support the allegation ‘Failure to provide required Basic Services.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

Regarding the allegation, ‘Failure to maintain facility clean, safe and sanitary,’ the complainant’s concern is that R1’s room was unkempt, which poses a potential safety risk to R1, as there were unclear walkways during the complainant’s visit.

Continue on LIC 9099C..

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 29-AS-20200820143226

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: 03/29/2022

NARRATIVE

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During the investigation, LPA Miller conducted a tour via ‘facetime,’ of R1’s bedroom on 08/24/2020 at 3:15 p.m. During the tour, housekeeping was brought to attention due to excessive messiness at the time of observation. LPA Miller noted R2 tended to hoard. LPA Miller was advised that R2 recently discarded belongings. During today’s visit, LPA Walker conducted interviews with S1, the administrator, R2, and R1’s family member. Interviews with S1, and the administrator confirmed that R2 has a lot of belongings, and would ‘have the room out of order.’ Interview with the administrator also revealed, that staff have brought the housekeeping rules to R2’s attention, and the ‘hoarding’ has improved. Upon entry to R1 and R2’s bedroom, the LPA observed several belongings stored in the bedroom. However, the belongings were in order, and the room appear to be clean. Interview with R2 revealed, that staff clean their room ‘every day, seven days a week.’ Interview with R2 also revealed, that R2 acknowledges the ‘room is a bit full of items.’ Interview with R1’s family member revealed, that R1’s ‘room was always in order, ‘It wasn’t messy,’ R1 ‘was organized,’ and ‘staff would clean every day.’ Interview with R1’s family member also revealed, that staff would assist R1 in getting up from bed to change the sheets daily.

Based on LPA’s observation, and Interviews conducted with S1, the administrator, R2, and R1’s family member. Although, R1 and R2’s bedroom contains several personal belongings, the facility staff ensure their room is clean, safe, and sanitary. Therefore, there is insufficient evidence to support the allegation ‘Failure to maintain facility clean, safe and sanitary.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

Regarding the allegation, ‘Failure to meet residents needs for restricted health care conditions,’ the complainant’s concern is that R1’s vitals were not within normal limits. The complainant was also concerned that R1 did not have proper oxygen supplies, and that staff were not aware R1 needed oxygen.

During the investigation, LPA Walker conducted a record review, interviews with the administrator, R2, and R1’s family member. Interview with the administrator revealed, that R1 ‘was never on Oxygen,’ and ‘there was no physicians order for oxygen’ while R1 was residing at the facility. Interview with the administrator also revealed, that R1’s roommate required oxygen, and that there were times R2 would share their oxygen with R1, against staff instructions not to, as it was not prescribed by R1’s primary physician.
Continue on LIC 9099C..

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 29-AS-20200820143226

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: 03/29/2022

NARRATIVE

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During interview with R2, R2 denied sharing oxygen with R1 stating ‘you can’t do that without doctor’s orders.’ Interview with R1’s family member revealed, that R1 did not require oxygen supplies. Record review revealed, that there is no physicians order for oxygen prescribed to R1, nor that R1 required any oxygen supplies during R1’s stay at the facility.

Based on record review, and Interviews conducted with the administrator, R2, and R1’s family member R1 did not have any physicians orders for oxygen supplies while living at the facility. Therefore, there is insufficient evidence to support the allegation ‘Failure to meet residents needs for restricted health care conditions.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

Regarding the allegation, ‘Failure to ensure compliance with personnel requirements,’ the complainant’s concern is that the facility staff had no knowledge of R1's needs for service, and that R1 was scheduled for dialysis. The complainant’s concern was also, that facility staff were unaware that R1 was living at the facility at the time of the visit.

During the investigation, LPA Walker conducted interviews with S1, the administrator, and R1’s family member. Interview with S1 revealed, that ‘S1 and the Administrator were in charge of arranging transportation for R1’s dialysis.’ Interview with the administrator revealed, that the administrator and the facility med tech are the two (2) staff that have always scheduled and arranged transportation. Interview with the administrator also revealed, that there were times the arranged transportation would not show for R1, and the administrator would have to transport R1 themselves to the Dialysis appointments. The Administrator denied allegations of facility staff having no knowledge of R1’s needs for services, and scheduled transportation to Dialysis appointments. Interview with R1’s family member revealed, that R1 had Dialysis appointments ‘once a day,’ and that Staff would call R1’s family member if the facility was running late for R1’s Dialysis appointments.

Continue on LIC 9099C..

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 29-AS-20200820143226

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: 03/29/2022

NARRATIVE

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Based on interviews conducted with S1, the administrator, and R1’s family member, the facility staff were aware of R1’s needs for service, scheduled Dialysis appointments, and the facility staff were aware that R1 was living at the facility at the time of the visit. Therefore, there is insufficient evidence to support the allegation ‘Failure to ensure compliance with personnel requirements.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted, and a copy of the report was provided.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

LIC9099 (FAS) - (06/04)

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