197608280-4-15-2022-29-AS-JAPL-CDR3CG-20220422180756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 04/15/2022
Date Signed: 04/15/2022 03:51:06 PM

Substantiated

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
01/14/2022 and conducted by Evaluator Elsie Campos

COMPLAINT CONTROL NUMBER: 29-AS-20220114163908

FACILITY NAME:	FOUR SEASONS ASSISTED LIVING CENTER LLC		FACILITY NUMBER:	197608280
ADMINISTRATOR:	MELISSA CHRISTOPHER		FACILITY TYPE:	740
ADDRESS:	12120 CHANDLER BLVD		TELEPHONE:	(818) 487-0770
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91607
CAPACITY:	49	CENSUS: 31	DATE:	04/15/2022
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Socorro Rosas		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are not providing a safe enviornment for residents
Staff yelled at resident
Staff are not treating resident's with respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elsie Campos arrived unannounced for a subsequent complaint visit to deliver the findings for the above allegations. The LPA met with Med Tech Socorro Rosas and explained the reason for the visit. The LPA contacted the Administrator via telephone and also explained the reason for the visit. The Administrator authorized Med Tech Socorro Rosas to sign for the report.

During the initial visit on 1/19/22 the LPA interviewed the administrator at 3:45 p.m. and reviewed documents. The LPA conducted a subsequent visit on 4/1/22 and interviewed staff at 9:35 a.m., 1:00 p.m., 1:45 p.m., 1:57 p.m., and 2:20 p.m. The LPA reviewed documents at 9:40 a.m., conducted a brief plant tour at 10:40 a.m. and interviewed residents at 11:15 a.m. and 11:50 a.m. During the subsequent visit on 4/11/22 the LPA interviewed staff at 10:25 a.m., 10:48 a.m., 11:15 a.m.,11:38 a.m., 3:00 p.m., 3:33 p.m. and 3:48 p.m. The LPA interviewed residents at 1:05 p.m., 1:10 p.m., 1:25p.m., 1:30 p.m., 2:00 p.m., 2:15 p.m., 2:42 p.m. and 2:50 p.m.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022

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 29-AS-20220114163908

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: 04/15/2022

NARRATIVE

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Regarding the allegation: Staff are not providing a safe environment for residents
It was alleged that staff have had inappropriate interactions with residents, which has created an unsafe environment. For example, it was alleged that a staff threw a tray at a resident. To investigate, the LPA conducted interviews with residents and staff. Staff and residents confirmed that they have observed, overheard, or experienced elevated behavior from Staff #1 (S1). For example, interviews with staff and residents revealed that Staff #1 (S1) threw an insulin pen at a resident. It was mentioned that S1 was upset and responded in that manner because S1 was no longer allowed to help the resident administer the insulin injection. Staff #2 (S2) admitted to becoming frustrated with residents when they have had trouble being understood by the residents. This has prompted S2 to stop interacting with those residents to eliminate disagreements or further conflict. Interviews further revealed that S1 will display unwillingness to assist residents with requests when they are bothered. Staff interview revealed that Staff #3 (S3) has inappropriately handled residents when waking them, by taking off their blankets and forcing them up when they are not ready.

Based on the investigation, there is sufficient evidence to support the claim that staff are not providing a safe environment for residents. This allegation is deemed Substantiated at this time.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220114163908

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: 04/15/2022

NARRATIVE

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Regarding the allegations: Staff yelled at resident AND Staff are not treating residents with respect
It was alleged that staff yelled at residents. In addition, it was alleged that staff are demeaning and have no respect for the residents. To investigate, the LPA conducted interviews with residents and staff. In particular, it was mentioned that S1 and S2 have yelled at residents. Interviews revealed that due to staff having difficulty in communicating with residents, staff are not always able to transmit information or directions in a compassionate manner. Interviews confirmed that S1 and S2 have trouble communicating with English only speakers as their English may be fragmented and incomplete, because the staff’s knowledge of the vocabulary isn't as robust as an English speaker. This has presented a conflict between staff and residents as the resident’s perception of information received is taken as rude and disrespectful. Interviews further revealed that both staff and residents have observed, overheard, or experienced this behavior from staff, interviews from Residents confirmed that they have been yelled at by staff. Additionally, resident interviews confirmed that they will avoid requesting anything from S2 because they believe S2 is rude, and residents do not like how they are treated or talked to by S2. Both S1 and S2 have displayed inappropriate behavior, as they often offend residents and staff with her aggressive personality.

Based on the investigation, there is sufficient evidence to support the above mentioned claims. The allegations “Staff yelled at resident” and “Staff are not treating residents with respect” are Substantiated at this time.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D). Exit interview conducted. A copy of the report, and appeal rights, were issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220114163908

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/15/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/22/2022 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	87468.2 (a)(4)... Personal Rights of Residents in All Facilities,... shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.	1 2 3 4 5 6 7	The Administrator has agreed to do the following: 1. Administrator is going to talk to all staff to assess personal rights protocols and develop a plan to ensure that residents and staff are able to communicate effectively and efficiently. Communicate plan to CCLD by 4/22/2022.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as it was communicated that staff lack the sufficient skills to communicate in English, which poses a potential personal rights risk to residents in care.	8 9 10 11 12 13 14
Type B 04/22/2022 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1(a)(1) Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator has agreed to do the following: 1. Administrator is going to talk to all staff to assess personal rights protocols and develop a plan to ensure that residents and staff are able to communicate effectively and efficiently. Communicate plan to CCLD by 4/22/2022.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the section cited above, as it was communicated that residents were being yelled at in the facility by staff, which poses a potential personal rights risk to residents in care.	8 9 10 11 12 13 14

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: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022

LIC9099 (FAS) - (06/04)

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