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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608320
Report Date: 10/26/2020
Date Signed: 10/26/2020 10:56:33 AM



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 - #1FACILITY NUMBER:
197608320
ADMINISTRATOR:MARIA LUCHEROFACILITY TYPE:
740
ADDRESS:17220 BALLINGER STREETTELEPHONE:
(818) 772-1812
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:6CENSUS: 1DATE:
10/26/2020
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Maria LucheroTIME COMPLETED:
09:10 AM
ALLEGATION(S):
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Resident developed a pressure injury while in care
Licensee not following hospice care plan
Licensee not providing proper incontinence care
INVESTIGATION FINDINGS:
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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 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.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2020
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 5
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: 10/26/2020
NARRATIVE
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Regarding the allegation: Resident developed a pressure injury while in care
The complainant alleged that a stage 2 pressure injury was observed on resident #1 (R1) due to lack of care. Interviews and records review revealed that the pressure injury was observed by hospice on 1/3/2020 and care for the pressure injury was subsequently added to the care plan. Records revealed that R1 had a history of skin breakdown and staff were told to keep the area dry and to ensure linens were clean. The hospice care plan specified that R1 had to be taken to the bathroom every 2-3 hours to prevent R1 from sitting in urine. Interviews alleged that R1’s linens were ‘soaked’ with urine most mornings and linens had to be changed. Interviews confirmed that the R1 used pull-ups and an external catheter to supplement incontinence care, yet sometimes it was described as ‘improperly placed’. When the source of the wound was discussed, interviews revealed that moist skin and lack of repositioning could have aided in its development. Interviews with staff revealed that hospice workers managed the care of R1 and varying information was provided as to the care facility staff provided R1. On 1/17/2020, the facility submitted a report, noting that on 1/15/2020, R1 sustained a skin tear at the result of falling while under the care of hospice. It was reported that per this incident, R1’s skin tear was falsely identified as the pressure injury; however, records show that the pressure injury was observed and documented on the hospice care plan on 1/3/2020, prior to the incident on 1/15/2020. Based on the information obtained, there is sufficient evidence to support the claim that the resident developed a pressure injury due to lack of care. This allegation is deemed Substantiated at this time.

Regarding the allegation: Licensee not following hospice care plan
The complainant alleged that the Administrator took R1 and resident #2 (R2) to physicians not authorized in the hospice care plan. In addition, the Administrator did not allow hospice into the facility to provide care to R1. It was confirmed that R1’s Power of Attorney (POA) talked with the Administrator about taking R1 off of hospice on 1/16/2020. However, documentation confirmed that R1’s POA emailed the Administrator on 1/17/2020, 1/23/2020, and 1/24/2020 stating that they did not want services discontinued. The Administrator admittedly did not allow hospice workers into the facility on 1/17/2020, 1/22/2020, and 1/24/2020.

A review of documents revealed that on 6/1/2018, R1’s Power of Attorney (POA) authorized the Administrator to make health care decisions for R1. However, emails demonstrated that R1’s POA revoked the Administrator’s authorization to make medical decisions for R1 as of 1/24/2020 at 9:32am. However, the Administrator made the decision to take R1 to the doctor the afternoon of 1/24/2020. In addition, the Administrator did not have authorization to take R2 to a doctor not specified on the hospice care plan.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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: 10/26/2020
NARRATIVE
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Hospice notes confirmed that R2’s responsible party was unaware that R2 was going to a doctor not specified on the hospice care plan. Per regulation, the written hospice care plan specifies the necessary medical intervention necessary for residents on hospice; the Administrator made the sole decision to take the residents to a physician not specified on plan. In addition, hospice workers were refused entry to provide resident care on 1/17/2020, 1/22/2020, and 1/24/2020. Based on the information obtained, there is sufficient evidence to support the claim that the licensee was not following the hospice care plan for R1 and R2. This allegation is deemed Substantiated at this time.

Regarding the allegation: Licensee not providing proper incontinence care
The complainant alleged that the Administrator used an external catheter for the residents at night in lieu of providing proper incontinence care. Interviews confirmed that R1 and R2 were using a Purewick catheter. However, this device was not prescribed by the residents’ primary care physician nor was it specified on the hospice care plan. Whereas staff claimed that R1 and R2 were taken to the bathroom, interviews revealed that R1’s sheets were often soaked in urine each morning. Interviews also revealed that R2 removed the catheter and it would be found on the floor in the morning. It was confirmed that in addition to the external catheter, R1 and R2 used pull-ups. Whereas staff stated that hospice confirmed the use of the catheter, these claims were negated. Based on the information provided, there is sufficient evidence to support the claim that licensee did not provide proper incontinence care. Lastly, when staff were questioned if the residents were changed, they stated that ‘hospice’ would change the residents in the morning and could not provide adequate information. This allegation is deemed Substantiated at this time.

The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report was provided via email for signature, along with the appeal rights.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/28/2020
Section Cited
CCR
87464(f)(1)
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Basic Services. Basic services shall at a minimum include: (1) care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c)

This requirement is not met as evidenced by:
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The Administrator has agreed to do the following:
1. Submit a Plan of Action, detailing how this facility will care for residents that are prone to sustaining healing wounds. Submit the Plan of Action no later than 10/28/2020.
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Based on interview and records review, the licensee did not comply with the section cited above, as R1 developed a stage 2 pressure injury as a result of lack of care, which poses an immediate health and safety risk to residents in care.
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Type B
10/30/2020
Section Cited
CCR
87633(a)(4)
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Hospice Care of Terminally Ill Residents. A written hospice care plan which specifies the care, services, and necessary medical intervention... is developed ... and all hospice care plans are fully implemented by the licensee and by the hospice(s).
This requirement is not met as evidenced by:
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The Administrator has agreed to do the following:
1. Review Regulation 87633, and submit a Statement of Understanding to CCLD no later than 10/30/2020.
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This requirement is not met as evidenced by:
Based on interview and records review, the licensee did not comply with the section cited above, as the licensee did not follow the hospice care plan for R1 and R2, which poses a potential health and safety risk to residents in care.
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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 PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2020
Section Cited
CCR
87625(b)(4)
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Managed Incontinence. The licensee shall be responsible for...: Ensuring that bowel and/or bladder programs are designed by an appropriately skilled professional with training and experience in care of elderly persons with bowel and/or bladder dysfunction.
This requirement is not met as evidenced by:
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The Administrator has agreed to do the following:
1. Review Regulation 87625 and submit a Statement of Understanding to CCLD no later than 10/30/2020.
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Based on interview, the licensee failed to comply with the section cited above, as an external catheter was used for R1 and R2 yet it was not authorized by hospice or any other appropriately skilled professional. This poses a potential health and safety risk to residents in care.
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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 PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2020
LIC9099 (FAS) - (06/04)
Page: 5 of 5