197603296-2-7-2024-31-AS-MVAO-D2N273-20240220160805

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603296
Report Date: 02/07/2024
Date Signed: 02/07/2024 01:48:17 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/02/2024 and conducted by Evaluator Gina Saucedo

COMPLAINT CONTROL NUMBER: 31-AS-20240202120520

FACILITY NAME:	FAIRWINDS - WEST HILLS		FACILITY NUMBER:	197603296
ADMINISTRATOR:	ELVIS GUTIERREZ		FACILITY TYPE:	740
ADDRESS:	8138 WOODLAKE AVE		TELEPHONE:	(818) 713-0900
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91304
CAPACITY:	130	CENSUS: 104	DATE:	02/07/2024
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Elvis Gutierrez		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility failed to follow regulations adopted by the State Fire Marshal for the protection of life and property against fire.
Facility did not follow Covid-19 protocol.

INVESTIGATION FINDINGS:

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On 02/07/24, at 8:50am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator Elvis Gutierrez. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather information, interviews and deliver findings for this complaint.

The investigation consisted of the following: LPA Saucedo asked for the census, requested the staff and resident roster. At 9:45am, LPA toured the physical plant, conducted staff and resident interviews, and received documentation regarding the above allegation(s).

9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

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 31-AS-20240202120520

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: FAIRWINDS - WEST HILLS	FACILITY NUMBER: 197603296
	VISIT DATE: 02/07/2024

NARRATIVE

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Regarding the allegation: Facility failed to follow regulations adopted by the State Fire Marshal for the protection of life and property against fire. It’s being alleged that RP states facility is not following brush clearance requirements and not enough is being done by the facility to clear potential fire hazards from hill side. During, LPA's physical plant tour, LPA did not observe any bushes to be overgrown. There are pictures to prove that the bushes and pine trees are being kept to Fire Marshal code which is not to exceed three (3) inches in height. There is also an email from Linsay Pellegrini Inspector I, Valley Public Safety Unit and an interview that the LPA conducted clearing the above facility of any fire hazard violation. The interview states that the Pine Trees are alive and that causes no fire hazard violation and that there was a removal of a fallen branch between the intersection of Woodlake and Roscoe that was picked up. Also, there is a fire clearance dated 02/02/24 for the above facility that was obtained by the LPA from the City of Los Angeles. Eight (8) out of ten (10) residents were interviewed regarding the above allegation(s) and there was no concerns. In addition, there was also seven (7) staff that were interviewed regarding the above allegation(s) and there were no concerns. The staff also received a recent, simulated fire drill on 12/12/23 so they can be aware about fire procedures. Furthermore, there is a red binder in the front entrance of the facility that is titled Emergency Procedure Manual and Exposure Control Plan (ECP) which has a facility sketch, evacuation routes and infection control procedures for both the staff and residents to view and obtain information that was reviewed by the LPA. Therefore, based on the LPA's interviews, observations, and record reviews the above allegation(s) above is unsubstantiated at this time.

Regarding the allegation: Facility did not follow Covid-19 protocol. It’s being alleged that RP states there were three cases of Covid on December 28, 2023 and Fairwinds protocol was not that prescribed by government...also at the facility there were very concerned when "medical" cleared husbands of those in Quarantine to roam, including dining-room...they said it's was ok for occupant to "get mail", etc.. Another person, in quarantine was also free to roam anywhere. LPA was able to obtain the Unusual Incident/Injury Report sent to Community Care Licensing Division (CCLD) regarding the residents that recently had Covid-19 and the reporting email to the Public Health with covid guidance. A town hall agenda and meeting were also held on 01/31/24 with residents that wanted to attend listing the Emergency Procedure Binder as one of the topics which has the infection control procedure included.

LIC 9099C-continued

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240202120520

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: FAIRWINDS - WEST HILLS	FACILITY NUMBER: 197603296
	VISIT DATE: 02/07/2024

NARRATIVE

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Eight (8) out of ten (10) residents were interviewed in regards to the above allegation(s) and there was no concerns. Eight (8) out of ten (10) residents stated similar protocol that residents are not allowed out of there room if they test positive for Covid-19. The residents also stated that they get room service where food is delivered to their room and they not allowed to enter the dining hall to eat. There was also seven (7) staff that were interviewed regarding the above allegation(s). Two of the Health and Wellness staff were interviewed and described the Covid-19 procedures. They both stated that once the resident has Covid-19 symptoms or has been exposed to someone that had Covid-19 they shall be tested. Once they are tested and the result is positive the resident immediately is isolated in their room for about five (5) days. There are then two signs displayed outside of the their room alerting anyone entering the room or close by the room and there is one sign in the room to remind the resident that they are Covid-19 positive. There is a bin then kept outside of the room with gloves, hand sanitizer, mask, wipes for resident to use if needed. Another bin is kept in the room which is red for laundry that is to be washed separately. The resident is then retested until a negative test is shown and the resident can go on to route procedures. The administrator was interviewed and described the Covid-19 procedure is to report to CCLD, public health and then follow precautions regarding the Covid-19 and its procedures for not only residents infected but to prevent further spread. Therefore, based on the LPA's interviews, observations, and record reviews the above allegation(s) above is unsubstantiated at this time.

An exit interview was conducted, no citations were issued for the two (2) above allegations, and a copy of this report was given to the administrator.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

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