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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603599
Report Date: 09/03/2024
Date Signed: 09/03/2024 02:58:55 PM

Substantiated


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
08/26/2024 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20240826142332
FACILITY NAME:BEST ELDER CAREFACILITY NUMBER:
197603599
ADMINISTRATOR:IGID, FABIOLAFACILITY TYPE:
740
ADDRESS:37620 SIMI STREETTELEPHONE:
(661) 878-8105
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:6CENSUS: 5DATE:
09/03/2024
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Gemma Wanawan (Staff)TIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff does not ensure resident is spoken to in an appropriate manner.
Staff did not allow resident access to their walker.
INVESTIGATION FINDINGS:
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At 10:20 a.m. Licensing Program Analysts (LPAs) Evelin Rios and Angelica Segovia arrived at the facility to conduct an unannounced complaint visit. Upon arrival, LPAs knocked on the door and were greeted by staff, Gemma Wanawan who granted access. LPA requested Gemma contact the administrator. LPA Rios spoke to the administrator Fabiloa Igid and LPA explained the reason for the visit. The administrator informed LPAs that she is not available to meet them at the facility but would be available via telephone. The administrator designated staff, Gemma to sign today's report.

At approximately 10:30 a.m. LPAs conducted a physical plant inspection to assure the health and safety of the residents in care. From 10:41 a.m. to 11:40 a.m. LPAs interviewed two (2) staff, two (2) residents present at the facility and conducted a telephone interview with the administrator. From 11:41 a.m. to 12:00 p.m. LPAs reviewed and requested copies of documents relevant to this investigation. LPAs obtained the facility roster, LIC 500, facility notes on resident #1(R1), R1's physician report, preplacement appraisal, resident appraisal and appraisal needs and services. (Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
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 5
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
08/26/2024 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20240826142332

FACILITY NAME:BEST ELDER CAREFACILITY NUMBER:
197603599
ADMINISTRATOR:IGID, FABIOLAFACILITY TYPE:
740
ADDRESS:37620 SIMI STREETTELEPHONE:
(661) 878-8105
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:6CENSUS: 5DATE:
09/03/2024
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Gemma WanawanTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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9
Staff does not ensure residents room is kept in clean conditions at all times.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Evelin Rios and Angelica Segovia conducted a complaint visit to facility to investigate the above allegation. During the course of the investigation, interveiws were conducted and an inspection of the physical plant was made.

Allegation: Staff does not ensure residents room is kept in clean conditions at all times.
Regarding allegation, it was reported that Resident 1 (R1) was not feeling well and vomited in their trash bin. R1 then asked staff#2 (S2) to empty out trash bin but S2 refused. To investigate the allegation LPAs interviewed the administrator, two (2) out of two (2) staff and two (2) out of five (5) residents present at the facility. Per interviews with staff, and R1, R1 threw up in a bathroom trash bin and informed staff to take out the trash bin. Interview with both staff deny the allegation stating the trash bin was emptied. S2 states they held up the bag with vomit to show R1 they had taken it out.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20240826142332
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: BEST ELDER CARE
FACILITY NUMBER: 197603599
VISIT DATE: 09/03/2024
NARRATIVE
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 Interview with resident #2 (R2) had no issues or concerns with cleanliness of the facility or receiving assistance when requesting staff to clean something in their room. LPA’s interview with R2 also revealed they have no issues or concerns with the cleanliness of the bathrooms. Furthermore, LPA’s interview with R1 revealed they do not have issues or concerns with staff cleaning their bedroom and they have an arrangement with staff about how and what they are allowed to clean in their room. LPA Rios, confirmed with staff that they are not allowed to dust R1’s TV and dresser area. LPA observed R1's room to be clean and maintained at the time of the visit. Based on the interviews and physical plant inspection the allegation is deemed Unsubstantiated at this time.


Exit interview. Copy of report provided.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20240826142332
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: BEST ELDER CARE
FACILITY NUMBER: 197603599
VISIT DATE: 09/03/2024
NARRATIVE
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Allegation: Staff does not ensure resident is spoken to in an appropriate manner. Regarding this allegation, it was reported that resident #1 (R1) and staff #2 (S2) got into a verbal altercation. To investigate the allegation LPAs interviewed the administrator, two (2) out of two (2) staff and two (2) out of five (5) residents present at the facility. LPA’s interview with R1 revealed they got into an argument with S2 over cleaning out a trash bin R1 had vomited in. According to R1, staff #2 (S2) was yelling and making threats to throw R1 in a trash bin. LPA’s interview with S1 and S2 corroborates there was an argument between R1 and S2. Interview with S2 confirms they did get "a little loud" but that S2 was explaining to R1 that they should have courtesy towards others. Interview with the administrator revealed, R1 has an attitude and staff and other residents have complained about R1’s behavior. The administrator directed staff to keep notes on incidents that occur involving R1. Based on interviews the allegation is deemed Substantiated at this time.

Allegation: Staff did not allow resident access to their walker. In regards to the allegation, it was reported staff #2 (S2) took resident #1’s (R1’s) walker out of their room as a form of punishment. To investigate the allegation LPAs interviewed the administrator, two (2) out of two (2) staff and two (2) out of five (5) residents present at the facility. LPA’s interview with R1 revealed they got into an argument with S2 over cleaning out a trash bin R1 had vomited in. According to R1 they had informed Gemma, staff #1 (S1) that the trash bin needed to be emptied because they had vomited in it. R1 then stated they could hear S2 yell at S1 and later S2 approached R1 threatening to throw R1 in the trash bin. R1 states that it could have been a misunderstanding. R1 went on to say S2 took R1s walker, and they argued back and forth about returning the walker. R1 states the walker was eventually returned and the issue was resolved. LPA’s interview with S1 and S2 corroborates there was an argument between R1 and S2. Staff state R1 was the instigator. Interview with S2 corroborates that they took the walker to show R1 a lesson, by stating, "for example if your walker is not here you cannot walk, same as us if we are not here you cannot eat." LPA’s interview with R1 and the administrator confirmed, R1 needs a walker to move around. Based on interviews this allegation is deemed Substantiated at this time.

Deficiencies cited (refer to LIC9099-C). Exit interview conducted. Appeal right provided. Copy of report provided.

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20240826142332
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: BEST ELDER CARE
FACILITY NUMBER: 197603599
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/04/2024
Section Cited
CCR
87468.1(a)(3)
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(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature... This requirement is not met as evidenced by:
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The Administrator will conduct in service training on the cited regulation 87468.1
Personal Rights of Residents in All Facilities and provide a staff sign in sheet by POC due date 09/04/2024 and provide copy to LPA.
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Based on interviews, the licensee did not comply with the section cited above as S2 confirmed they took R1's walker to teach to them a lesson which poses an immediate Health, Safety or Personal Rights risk to residents in care.
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Type B
09/20/2024
Section Cited
CCR
87468(a)(1)
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Personal Rights of Residents in All Facilities-To be accorded dignity in their personal relationships with staff, residents, and other persons.
This requirement was not met as evidenced by:
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The Administrator will have in service training for how their staff are required to de-escalate a situation with a resident. Administrator will provide a copy of the sign in sheet and the training material used. POC due date 09/20/2024 and provide copy to LPA.
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Based on interviews conducted it was revealed that S2 engaged in an argument with R1 and S2 confirms their voice was "a little bit loud", which posed a personal rights violation to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5