197608200-3-20-2024-31-AS-MVAO-D3YT4A-20240403142339

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608200
Report Date: 03/20/2024
Date Signed: 03/20/2024 12:55:06 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
12/11/2023 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20231211162011

FACILITY NAME:	ALTA VISTA GARDENS		FACILITY NUMBER:	197608200
ADMINISTRATOR:	STACI MARMERSHTEYN		FACILITY TYPE:	740
ADDRESS:	829 NORTH ALTA VISTA BLVD.		TELEPHONE:	(323) 937-1940
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	70	CENSUS: 70	DATE:	03/20/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Staci Marmershteyn		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Resident sustained an unexplained fracture while in care
Resident became malnourished while in care
Facility retains a resident with a higher level of care needs

INVESTIGATION FINDINGS:

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On 03/20/24, at 8:50am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Medical Technician, Deborah Dapson. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather additional information, conduct more interviews, and deliver findings for this complaint.

On 12/12/2023, LPA Gina Saucedo initiated the complaint investigation. The complaint was referred to Investigations Branch (IB) on 12/12/23 and accepted one (1) out of the three (3) allegations mentioned above. The investigator was John Canto. On 03/20/24, at 8:50AM, LPA asked for census, staff, and resident roster. At 9:20AM, LPA conducted the physical tour with facility Administrator, Staci Marmershteyn.

LIC 9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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-20231211162011

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: ALTA VISTA GARDENS	FACILITY NUMBER: 197608200
	VISIT DATE: 03/20/2024

NARRATIVE

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Regarding the allegation: Resident sustained an unexplained fracture while in care. It is being alleged that resident had facial edema, slight bruising to left eye and has a nasal fracture. On 12/13/23, IB Investigator, John Canto requested medical records from Norwalk Community Hospital. Resident #1 (R1) was transported there on 12/08/23 for hypertension and concerns with areas of the face, eyes, nose, and mouth. R1’s nasal deviation was noted as chronic. Upon admission to the hospital, R1 also had an altered mental status, hypertension, seizure disorder and dementia. On 12/11/23, it was noted on the CT Head Scan (without IV contrast) that there was no skull fracture; therefore, paranasal sinuses are normal as shown which confirms that R1 did not have any skull fractures. On 12/13/23, it was noted that R1 was sent to the emergency room due to edema of bilateral lower extremities. R1 had a history of bumping their head on the toilet and scooting on their knees. On 01/16/24, IB Investigator attempted to interview R1’s social worker but was unable to obtain an interview. On 02/06/24, IB Investigator Canto interviewed three (3) staff and one (1) out of three (3) residents. Two (2) residents were unable to participate due to their cognitive abilities. The three (3) staff were able to confirm that R1 was housed in the memory care unit, would scoot on their knees, would argue, steal from residents, and would overeat. The medical records from 12/12/23 for R1, shows no facial swelling and/or rashes and was normal. The nose also shows no mass or deformity. Based on the observation of the IB Investigator, interviews conducted, and record review, the allegation is UNSUBSTANTIATED.

Regarding the allegation: Resident became malnourished while in care. It is being alleged that the resident is very confused, malnourished, and thin. LPA was able to obtain the Physician’s report of 2023 which shows Resident #1 (R1) weighed 121lbs, the physician’s report of 2020 showed a weight of 115lbs which showed that R1 gained weight. In addition, the weight at the time of hospital admittance on 12/08/23 shows that R1 weight at 80 kilograms (176 lbs.). LPA interviewed seven (7) out of eight (8) that confirmed R1 would eat their own food and ask others for their food or sometimes even steal other resident’s food. LPA interviewed seven (7) residents out of eight (8) that also confirmed that they can receive extra food from the kitchen if they are still hungry. LPA was also able to interview four (4) out of four (4) staff that confirmed that R1 would steal food and request extra food from staff and other residents. Therefore, based on the LPA's interviews, observations, and record review, the above allegation(s) UNSUBSTANTIATED.

LIC 9099C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20231211162011

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: ALTA VISTA GARDENS	FACILITY NUMBER: 197608200
	VISIT DATE: 03/20/2024

NARRATIVE

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Regarding the allegation: Facility retains a resident with a higher level of care needs. It is being alleged that the resident needs a higher level of care due to their severe dementia. The facility Administrator was able to provide the LPA with the referral name and number to the Department of Health Services (DHS) in which the facility Administrator has made several attempts to help Resident #1 (R1) get a higher level of care. The facility Administrator confirmed that R1’s mental status has deteriorated since R1 has arrived at the facility. LPA was able to interview the DHS-Lisa Speights that oversees R1’s referral from the facility. DHS was able to confirm that the facility has made several attempts to try to get R1 more care and help but DHS stated it is not that easy. DHS stated there is several steps to this process and it will still take a while to get R1 to be moved from the above facility. LPA was able to interview four (4) staff that were able to state how each resident’s level of care differentiates between each other and how they provide that level of care. Four (4) out of four (4) staff also confirmed that R1’s level of care had deteriorated. LPA was also able to interview seven (7) out of eight (8) residents regarding their level of care. Seven (7) out of eight (8) residents confirmed that their level of care needs is met by the staff, case managers and social workers. Therefore, based on the LPA's interviews and record review the above allegation(s) is UNSUBSTANTIATED.

An exit interview was conducted, no citations were issued for the above allegation(s), and a copy of this report was given to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

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