197608320-3-26-2021-31-AS-JAPL-BZLVVF-20210330164618

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608320
Report Date: 03/26/2021
Date Signed: 03/26/2021 11:31:24 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 Aja Richardson

COMPLAINT CONTROL NUMBER: 31-AS-20200129165722

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: 0	DATE:	03/26/2021
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Maria Luchero, Administrator		TIME COMPLETED:	09:00 PM

ALLEGATION(S):

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Licensee did not allow residents to have visits from the spiritual advisor of their choice
Staff not administering medications as prescribed
Facility releasing unauthorized videos and medical information
Licensee making false statements about the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Aja Richardson conducted an unannounced visit to deliver the findings on the above allegations. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint visit was conducted telephonically with Maria Luchero, the facility administrator.
Allegation #1:
Licensee did not allow residents to have visits from the spiritual advisor of their choice. In order to investigate this allegation, on 2/7/20, LPA conducted interviews with the Administrator and resident currently living at facility, and Resident #1 (R1) responsible party. On 2/20/20, LPA conducted interviews with (R1) spiritual advisor, and on 3/13/21, with R1’s hospice nurse. According to interviews conducted, R1 did not want to continue seeing the spiritual advisor and would get irritated when the spiritual advisor would come. In addition, the Administrator stated they never stopped the spiritual advisor from coming.
Continued 9099...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja Richardson	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

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-20200129165722

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: 03/26/2021

NARRATIVE

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Based on interviews conducted both the responsible parties for R1 and Resident #2 (R2) verbally expressed to Administrator that they were in agreement that R1 and R2 did not enjoy the time with Spiritual Advisor. Based on interviews conducted there is insufficient evidence that the Administrator stopped the spiritual advisor from coming. This allegation is Unsubstantiated at this time.

Allegation: #2: Staff not administering medications as prescribed. There are concerns that when R1 moved out of facility the Administrator did not release all of R1’s medication. In addition, when R1 moved to new facility and reassessed R1 did not need all of the medication that the Administrator stated R1 needed for pain. To investigate this information, LPA on 2/7/20 conducted medical record review of R1’s medications. On 2/7/21, LPA conducted interviews with the Administrator, resident currently living at facility, and Resident #1 (R1) responsible party. On 3/13/21, LPA conducted interviews with R1’s hospice nurse and on 3/15/2021 with R1’s hospice Director of Nursing. According to interviews with R1’s hospice nurse and record review while R1 was living at the facility, R1 medications were given as prescribed by R1’s primary care physician. Based on record review and interviews there is insufficient evidence that while R1 was living at facility that R1 was not given the medication as prescribed. This allegation is Unsubstantiated at this time.

Allegation: #3: Facility releasing unauthorized videos and medical information. There are concerns that the Administrator recorded the Hospice nurse providing care and distributed it. To investigate this allegation, on 2/7/20, LPA conducted interviews with the Administrator and resident currently living at facility, and (R1) responsible party, on 2/20/20, LPA conducted interviews with, and on 3/13/21, with R1’s hospice nurse, and on 3/15/21 with the hospice agency director of nursing. According to interviews the Administrator videotaped Hospice nurse entering the facility due to allegations that Administrator did not allow hospice agency to enter facility. According to interviews with the Administrator the video was not distributed and there is no recording of the hospice nurse providing care. Interviews conducted revealed that the Hospice Nursewas not aware that of recording and did not have an issue. There is no evidence that this video was given to anyone and that it showed the nurse providing care. Based on this information this allegation is Unsubstantiated at this time.

Continued on 9099C..

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja Richardson	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20200129165722

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: 03/26/2021

NARRATIVE

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Allegation #4: Licensee making false statements about the facility. There are concerns that the Licensee gave false information regarding hospice worker leaving residents alone in shower. To investigate this allegation on 2/7/20, LPA conducted interviews with the Administrator and resident currently living at facility. On 2/20/2021 LPA conducted interview with (R1) responsible party, on 3/13/21, with R1’s hospice nurse, and on 3/15/21 with the hospice agency director of nursing. According to interviews with the Administrator and resident currently living at facility, the hospice employee was witnessed leaving resident in shower alone. There is no evidence that the Administrator provided false statements about the hospice worker as the Administrator role is to report incidents that may pose a potential health and safety risk to residents in care. Based on the information provided this allegation is Unsubstantiated at this time.

Exit Interview Conducted. Report emailed to Administrator for Signature.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja Richardson	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021

LIC9099 (FAS) - (06/04)

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