197603894-8-19-2020-31-AS-CHAS-BTSRB3-20200925125205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603894
Report Date: 08/17/2020
Date Signed: 08/19/2020 03:15:44 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/04/2020 and conducted by Evaluator Yelena Avetisyan

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20200304105922

FACILITY NAME:	AEGIS OF GRANADA HILLS		FACILITY NUMBER:	197603894
ADMINISTRATOR:	LANCE SHENK		FACILITY TYPE:	740
ADDRESS:	10801 LINDLEY AVE.		TELEPHONE:	(818) 363-3373
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	100	CENSUS: 82	DATE:	08/17/2020
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Lance Shenk		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident # 1 (R1) was hospitalized due to being overmedicated/overdosed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Yelena Avetisyan conducted a subsequent complaint visit for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted telephonically at 03:00 pm with Administrator Lance Shenk.

In regards to the complaint investigation, it is being alleged that on 3/1/2020, Resident 1 (R1) was found unresponsive and hospitalized due to a opiate overdose. During the initial 10 day complaint visit LPA condcuted on 3/12/2020 LPA conducted review of records and medications for R1, additionally LPA condcuted interview with staff who was working when the incident occured.

On 3/10/2020, LPA requested records from Northridge Hospital for the 3/1/2020 hospitalization. Records reviewed revealed that upon admission, the Emergency Room (ER) physician ordered various lab tests which included a urine test for opiates. The lab results did not detect opiates adminstered to R1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Yelena Avetisyan	TELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2020

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-20200304105922

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AEGIS OF GRANADA HILLS	FACILITY NUMBER: 197603894
	VISIT DATE: 08/17/2020

NARRATIVE

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On 3/13/2020, a pharmacy audit was conducted by Ron's Pharmacy for the facility. At the time of the audit the pharmacy completed a count of all the narcotics and did not document any errors.

Additional information obtained during the course of the investigation revealed that in February 2019, a similar incident occurred when R1 was found unresponsive and non-arousable. However, when ambulance arrived R1 was responsive and refused transport.

Based on the records reviewed and interviews conducted, the department did not obtain sufficient information to determine that " Resident # 1 (R1) was hospitalized due to being over-medicated/overdosed" therefore the allegation is Unsubstantiated at this time.

A telephonic exit interview was conducted and a hard copy of this report provided via email for signature

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Yelena Avetisyan	TELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2020

LIC9099 (FAS) - (06/04)

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