197603296-12-18-2023-31-AS-RORN-D5SSY4-20240531141654

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603296
Report Date: 12/18/2023
Date Signed: 12/18/2023 04:38:36 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
12/08/2023 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20231208140029

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: 106	DATE:	12/18/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Elvis Gutierrez		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Emergency disaster plan is not sufficient to meet the needs of residents in an emergency.

INVESTIGATION FINDINGS:

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On 12/18/2023 at 10:00 a.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conducted a complaint visit to investigate the above mentioned allegation. LPA was greeted by the General Manager (GM) Elvis Gutierrez. LPA explained the purpose of the visit. LPA interviewed the GM at 10:12 a.m. and obtained copies of the facility's Emergency and Disaster Plan (LIC610E), Building Emergencies - Electrical Outages plan pulled from the Emergency Procedure Manual, a list of the residents in the facility which reflect provisions for appropriate support in the event of an emergency, maintenance log of facility's generator, and a facility calendar displaying a Town Hall Meeting May 31, 2023. At 10:52 a.m. LPA along with the GM conducted a physical plant inspection to assure the health a safety of the residents.

Allegation: Emergency disaster plan is not sufficient to meet the needs of residents in an emergency. It was alleged if the facility experiences a power outage lasting longer then 8 hours the one generator the facility has is insufficient. (CONT. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

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 31-AS-20231208140029

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: FAIRWINDS - WEST HILLS	FACILITY NUMBER: 197603296
	VISIT DATE: 12/18/2023

NARRATIVE

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(CONT. from LIC 9099-C)
To investigate the allegation LPA reviewed the facility's Emergency and Disaster plan along with the supplemental and the electrical outages plan. Interview with GM confirms the facility experienced a power outage on two occasions. One on 11/18/2023 lasting approximately an hour and a second one on 11/20/2023 lasting approximately 10 hours. The documents revealed the facility is equipped with one generator that will support emergency lighting communication and the building fire system. Facility also listed maintaining a list or residents dependent on electrical power usage for health maintenance and would have at least one flashlight or portable lighting devise in designated areas. Furthermore documents revealed staff would be required to check on residents every two hours and provide assistance and support to residents dependent on electrical power usage for health maintenance as needed. Interviews with staff and residents revealed facility made available to every resident a flashlight. LPA interview with residents dependent on oxygen and those not dependent reported the staff came into their rooms and checked on them while facility had the power outages. Facility records revealed at the time of the incident three residents were dependent on oxygen and 1 resident uses a wheelchair on the second floor. According to the GM the facility utilized the generator to charge batteries for the oxygen tanks and residents where able to switch out batteries to continue charging them. GM also stated residents could be assisted down the stairs to plug into a line that was directly plugged into the generator to continuously use oxygen devise. LPA observed one of two emergency chairs to assists residents down stairs during an emergency. According to residents and staff facility was able to obtain oxygen cylinders. LPA discussed with GM that facility should consider supplementing Emergency and Disaster Plan to include a procedure addressing residents dependent on oxygen in a disaster lasting longer then 72 hours and have residents input on such procedure. Based on record review and interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC9099 (FAS) - (06/04)

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