197608320-9-29-2020-31-AS-JAPL-BVUQ8D-20201130105628

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608320
Report Date: 09/29/2020
Date Signed: 09/29/2020 03:11:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/29/2020 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 31-AS-20200129144221

FACILITY NAME:	STUDIO CITY SENIOR CARE - #1		FACILITY NUMBER:	197608320
ADMINISTRATOR:	MARIA LUCHERO		FACILITY TYPE:	740
ADDRESS:	17220 BALLINGER STREET		TELEPHONE:	(818) 772-1812
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	6	CENSUS: 1	DATE:	09/29/2020
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Maria Luchero		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

1. Absence of supervision
2. Licensee did not inform representatives of activities related to resident's care
3. Licensee refusing to allow resident to leave facility
4. Staff did not change residents' clothing
5. Insufficient staffing to meet residents needs

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Ashley Smith conducted a subsequent complaint investigation to deliver the findings for the above allegations. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically at 2:15pm with Administrator Maria Luchero. Entrance interview conducted.

On 2/7/2020, LPA A. Richardson conducted the initial visit, completed a tour at 9am, interviewed the Administrator at 9:30am, and obtained documents at 11am. On 2/13/2020, LPA Richardson and LPA A. Smith completed a visit and interviewed the Administrator at 10:12am, conducted a file review and plant tour, interviewed staff at 12:48pm, 12:54pm, 12:56pm; and, interviewed a responsible party at 12:58pm. In addition, LPA Smith interviewed the Administrator on 2/26/2020 at 1:29pm, interviewed a hospice representative on 2/27/2020 and on 4/28/2020 at 4:32pm; interviewed a responsible party on 2/27/2020 at 2:59pm; interviewed staff on 2/26/2020 at 1:13pm, on 2/27/2020 at 4pm and on 4/28/2020 at 11am; and, interviewed the Administrator on 7/15/2020 at 9:28am.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

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-20200129144221

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: STUDIO CITY SENIOR CARE - #1	FACILITY NUMBER: 197608320
	VISIT DATE: 09/29/2020

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

Regarding the allegation: Absence of supervision
The complainant alleged that in the morning, the licensee would leave hospice workers alone with residents and no other staff were present in the facility. Individuals whom worked in the morning could not provide substantial information to support the claim that there was an absence of supervision in the morning. Interviews with facility staff, hospice workers, and a review of staff schedules revealed that there was always at least one facility staff person on the premises. There is insufficient evidence to confirm that hospice workers were left alone with residents. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Licensee did not inform representatives of activities related to residents care
The complainant alleged that representatives were unaware of activities related to resident care. Interviews conducted and records reviewed revealed inconclusive information; the Administrator was authorized to make medical decisions for Resident #1 (R1) and did so by the authority of R1’s Power of Attorney (POA). Documentation reviewed and interviews revealed that the Administrator and responsible parties were in regular communication, albeit some communication was in disagreement regarding appropriate care. There was inconclusive information as to whether the Administrator failed to keep Resident #2's (R2) responsible party informed, as they did not communicate any issues or concerns. Communication took place primarily through telephone calls and emails sparingly. There is insufficient evidence to support the claim that the licensee did not inform representatives of activities related to resident care. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Licensee refusing to allow resident to leave facility
The complainant alleged that the licensee did not allow R1 to leave the facility. Interviews revealed that on multiple days, (1/27/2020, 1/28/2020, 1/31/2020) R1’s responsible party attempted to visit R1. On those days, the Administrator either had the resident on an outing or at a doctor’s appointment. Interviews conducted revealed that the POA called and left messages for the Administrator on 1/27/2020, 1/28/2020 and 1/31/2020, but the voice mailbox was full and they were unable to leave a message. It was unclear if the POA followed up via email. It was alleged that the POA emailed the Administrator on 1/29/2020, stating that they would be removing R1 from the home on 1/31/2020; however, there was no supporting documentation to confirm this.

CONT 9099-C

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20200129144221

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: STUDIO CITY SENIOR CARE - #1	FACILITY NUMBER: 197608320
	VISIT DATE: 09/29/2020

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

As such, there was inconclusive information revealed regarding whether it was communicated that the POA wanted to remove R1 from the facility on 1/31/2020. The LPA observed email documentation from the POA to the Administrator, confirming that the POA would move R1 out of the home on 2/5/2020, which took place that day at 11am. R2 was also successfully moved out of the home on 1/27/2020.

Based on the information obtained, there is insufficient evidence to support the claim that the licensee refused to allow the resident to leave the facility. The Administrator was not present during the above-mentioned dates and did permit R1 to leave at the written request of the POA. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff did not change residents' clothing
The complainant alleged that the staff did not change resident clothing, as residents were observed in the same clothes the next morning. Interviews conducted with alert residents revealed that unless they were leaving the facility, they were comfortable staying in their ‘inside clothing’ and did not feel the need to change their clothes multiple times. Also, staff interviews revealed that they did change the resident clothing. During complaint visits, residents were observed to be dressed in appropriate attire Based on the information obtained, there was insufficient information to determine whether staff consistently failed to change resident clothing. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Insufficient staffing to meet the resident needs
The complainant alleged that the facility was unable to meet the resident needs. A review of the staffing roster revealed that there were multiple staff during the day, along with hospice staff. At night, there was at least 1-2 staff on duty. Per the review of appraisals and an audit of resident needs, there is insufficient evidence to support the claim that there was insufficient staffing to meet the needs of the residents. This allegation is deemed Unsubstantiated at this time.

No citations issued at this time. Exit interview conducted. A copy of the report was issued via email for signature.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 3