197608040-5-29-2024-31-AS-NGID-D68VBM-20240614161747

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608040
Report Date: 05/29/2024
Date Signed: 05/29/2024 03:41:16 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
05/22/2024 and conducted by Evaluator Lorena Casillas

COMPLAINT CONTROL NUMBER: 31-AS-20240522145500

FACILITY NAME:	SARAH'S CARE HOME		FACILITY NUMBER:	197608040
ADMINISTRATOR:	SARAH SHIRLEY		FACILITY TYPE:	740
ADDRESS:	43861 RYCKEBOSCH LANE		TELEPHONE:	(661) 946-0198
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	6	CENSUS: 5	DATE:	05/29/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Steve Racine		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not meet resident's bathing needs.
Staff did not seek medical attention for resident in care.
Staff do not ensure facility is free of lice resulting in residents being infected.
Staff do not ensure resident is being scheduled for therapy appointments.
Illegal eviction

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 05/29/24 at 10:00 am Licensing Program Analyst (LPA), Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegation. LPA met with Administrator Steven Racine and explained the reason for the visit.

At 10:10 AM LPA Casillas conducted a physical plant tour. During the investigation, interviews and record reviews were conducted. LPA requested copies of resident roster and LIC 500. LPA requested copies of pertinent information relevant to the investigation including but not limited to appraisals, police reports, police agency information and any information pertaining to residents and care.

During LPA’s visit Bristol Hospice Registered Nurse arrived and LPA was able to interview them and gather further information.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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-20240522145500

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: SARAH'S CARE HOME	FACILITY NUMBER: 197608040
	VISIT DATE: 05/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation #1 Staff does not meet resident's bathing needs.

It is alleged that staff do not meet residents’ bathing needs. Regarding this allegation it was reported that Resident #1 (R1) was only receiving bed baths every 8 days as opposed to regular baths, leaving R1’s legs and feet feeling unclean. LPA interviewed Administrator and staff and it was discovered that R1 cannot be left unattended in the shower and has refused help, therefore R1 has been given bed baths to keep them clean. Upon R1’s record review it was discovered that R1 is in Hospice and Hospice is in charge of R1’s bathing needs. LPA read R1’s medical assessment and Hospice documentation it was revealed that R1 cannot bathe on their own. The documentation revealed that R1 has refused to be bathed multiple times. Furthermore, interviews with residents revealed that they are cleaned often and helped with any and all grooming if they so chose it. Therefore, based on interviews, record reviews and observations this allegation is deemed Unsubstantiated.

Allegation #2 Staff did not seek medical attention for resident in care.

It is alleged that staff did not seek medical attention for resident in care. Regarding this allegation it was reported that Resident #1 (R1) was not helped with seeking medical attention for their concerns. LPA interviewed Administrator, staff and R1 and it was revealed that doctor appointments are done by Bristol Hospice. Furthermore, it was revealed that medical assistance such as calling 911 during an emergency has been used for all residents when it is needed. Resident interviews also revealed that they also have access to call 911 if they need to. R1 revealed during interview that their complaint is for Hospice care not the facility, they also admitted to getting the facility confused with Bristol Hospice. Therefore, based on LPA observations, record reviews and interviews this allegation is deemed Unsubstantiated.

Allegation #3 Staff do not ensure facility is free of lice resulting in residents being infected.

It is alleged that staff do not ensure facility is free of lice resulting in residents being infected. Regarding this allegation it was reported that facility staff have allowed residents to continue to have lice resulting in an infestation. LPA interviewed Administrator and staff and it was revealed that residents are free of lice or any other pests. Staff #1 (S1) states that they make sure that there are no lice on R1 or any of the residents since S1 is in close contact while providing care to residents. During LPA’s tour of the facility, it was observed that facility is clean and free of pests. During interview with four (4) of five (5) residents, LPA was informed that they do not have lice on their person. Therefore, based on interviews, record reviews and observations this allegation is deemed Unsubstantiated.

Continue on LIC9099-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20240522145500

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: SARAH'S CARE HOME	FACILITY NUMBER: 197608040
	VISIT DATE: 05/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation #4 Staff do not ensure resident is being scheduled for therapy appointments.

It is alleged that Staff do not ensure resident is being scheduled for therapy appointments. Regarding this allegation, it was reported that Resident #1 (R1) has not been scheduled for their physical therapy appointments. During the investigation LPA reviewed R1’s medical documentation and it was revealed that Bristol Hospice did an initial evaluation for R1 for Physical Therapy however R1 did not cooperate, and a complete evaluation was not able to me made. Furthermore, LPA interviewed Administrator, staff and Hospice Nurse and discovered that there was only an evaluation ordered but there is no physical therapy order documented or ordered from any provider. Therefore, based on interviews, observations, and record reviews this allegation is deemed Unsubstantiated.

Allegation #5 Illegal eviction

It is alleged that an Illegal Eviction has taken place. Regarding this allegation, it is reported that Resident #1 (R1) is being illegally evicted. LPA confirmed with Community Care Licensing (CCL) Regional Office (RO) that there was a denial for a 3-day eviction, however there is no evidence of a 30-day eviction. LPA interviewed Administrator and it was revealed that there has been no eviction notice initiated after the denial of the 3-day eviction notice. The facility Administrator stated that they have found a facility with the ability to care for R1, as this facility is not able to care for R1 appropriately based on their changing needs. However, R1 refuses to leave to a new facility. Administrator has stated that they will continue to provide care as best they can to all residents in care. Furthermore, interview with R1 revealed that they have not received any documentation regarding an eviction. R1 admits that they have refused the new facility. Therefore, based on interviews, observations, and record reviews this allegation is deemed Unsubstantiated.

No citations Issued. A copy of this report was given to Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3