197608280-2-22-2022-29-AS-JAPL-CBX34B-20220223165449

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 06/28/2021
Date Signed: 02/22/2022 12:46:40 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/19/2021 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20210519151334

FACILITY NAME:	FOUR SEASONS ASSISTED LIVING CENTER LLC		FACILITY NUMBER:	197608280
ADMINISTRATOR:	JOYCE ANN ALTAMIRANO		FACILITY TYPE:	740
ADDRESS:	12120 CHANDLER BLVD		TELEPHONE:	(818) 487-0770
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91607
CAPACITY:	49	CENSUS: 27	DATE:	06/28/2021
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Melissa Christopher		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility staff does not give medications as prescribed.
Facility staff mishandled resident's medications.
Facility does not serve food of the quality needed to meet residents’ needs.
Facility is not allowing resident to use a Home Health provider.

INVESTIGATION FINDINGS:

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This is an amended report. Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint investigation visit regarding the above noted allegations. During the initial visit on May 24, 2021 at 12:45 p.m., LPA Richardson conducted a brief facility tour and interviewed some residents in care. At 1:15 p.m., the LPA reviewed and obtained pertinent documents. At 1:30 p.m., the LPA conducted interviews with staff.
On this subsequent visit, LPA Urena arrived at the facility at 10:00 a.m. and met with the administrator, Melissa Christopher and explained the reason for the visit. LPA Urena conducted interviews between 10:15 a.m. and 2:00 p.m. with the administrator, Resident #1 (R1), R1’s primary physician, and a random selection of residents and staff. The LPA also observed meals being served from 12:00-12:30 p.m. in the dining room and delivered to resident rooms on the first floor. In addition, the LPA requested records, residents' files, menu, and medication logs to address the allegations.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

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 29-AS-20210519151334

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FOUR SEASONS ASSISTED LIVING CENTER LLC	FACILITY NUMBER: 197608280
	VISIT DATE: 06/28/2021

NARRATIVE

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Regarding the allegation, Facility staff does not give medications as prescribed, the complainant’ concern is that they believe that R1 is not getting their blood pressure/heart medications and a medication for R1’s hand/arm as prescribed. To conduct the investigation, LPA Urena interviewed the administrator, facility staff and residents. LPA Urena also conducted a records review of the Centrally Stored Medication (CSM) log for the facility. Upon review of the CSM log and the medication self-administration log, the LPA observed that residents are assisted with self-administration of medication according to the doctor’s instructions. Additionally, the medication self-administration logs also document residents’ refusal to take the medication as prescribed by their doctor and their reason for the refusal. It appears that R1 did refuse medication from time to time. Furthermore, LPA Urena observed communication between the facility staff and R1’s physician, informing the physician of the refusal of medication by R1 and requesting advice. Based on the investigation of records review, and interviews, there is insufficient evidence to support the claim that residents do not receive medications as prescribed. Therefore, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation, Facility staff mishandled resident medication, the complainant’s concern is that R1 was not receiving all of the medication that they brought to the facility upon admission. LPA Urena conducted a records review of Centrally Stored Medications and found that medications are being recorded for residents that arrive with medications at facility. The LPA reviewed the medication list in all of the residents’ files, and compared it to the medication log, and it appears that all medications are accounted for. The LPA also interviewed the administrator and facility staff, who confirmed this information as well. Based on the investigation, there is insufficient evidence to support the claim that R1’s medication was mishandled. Therefore, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Facility does not serve food of the quality needed to meet residents’ needs, the complainant’s concern was that the food was ‘nasty’. When asked for clarification, the complainant stated that they observed that the food appeared dry and there were no condiments available. To investigate this allegation, at 12:00 p.m., the LPA observed lunch being served in the dining room area and being delivered to residents residing on the first floor. Lunch was served according to the menu dated for the week of June 28^th through July 4^th, 2021. On this day, the food listed for lunch was Salisbury steak with grilled onions, diced fried potatoes, corn with green peppers, fresh green salad, and ice cream for dessert. A vegetarian substitution of grilled Tofu was available. Milk, and tea were part of the meal. Menu items are varied throughout the week. All menu items appear to be components of a balanced meal.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210519151334

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FOUR SEASONS ASSISTED LIVING CENTER LLC	FACILITY NUMBER: 197608280
	VISIT DATE: 06/28/2021

NARRATIVE

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The administrator stated that condiments are not kept on the dining room tables due to the varied dietary needs of the residents, but condiments are available upon request. The LPA observed today's lunch meal, the meal was appropriately arranged on the plate and did not appear to be dry. It also included a green salad which appeared fresh. Drinks were available on the same food tray. The meal was served as stated on the menu. Residents were also interviewed regarding the food and stated that food is ok, some days is better than others. Based on the investigation, there is insufficient evidence to support the claim that the facility does not serve food of the quality needed to meet residents’ needs. Therefore, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation, Facility is not allowing resident to use a Home Health provider, the complainant’s concern was that they believed that the facility was not allowing R1 to receive home health care services. To investigation the allegation, at 11:15 am, LPA Urena contacted R1’s primary care physician’s office to gather information about Home Health services for R1. Per the conversation with R1’s physician’s office staff, R1 requested Home Health Services and R1’s physician approved the services on 5/19/2021. However, per office staff and according to R1’s records, the Home Health Agency contacted R1 to review their insurance plan, at which time the Home Health Agency informed R1 that the portion to come out of pocket expense for the services would be 20% of the shared cost. At that time R1 declined the services. The Home Health Agency attempted to follow up with R1 but was unsuccessful in contacting R1. LPA Urena interviewed R1 about the information provided by R1’s primary physician’s office regarding the Home Health services and R1 indicated that the information provided was correct. R1 stated that communication has taken place with the insurance company in the last few days and that Home Health services are due to start on July 1, 2021.
Based on the investigation, there is insufficient evidence to support the claim that the facility is not allowing R1 to use a Home Health provider. Therefore, this allegation is deemed Unsubstantiated at this time.

No deficiencies were cited at this time. Exit interview conducted. Signatures obtained. A copy of report was provided.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

LIC9099 (FAS) - (06/04)

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