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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608320
Report Date: 04/23/2022
Date Signed: 05/16/2022 10:40:20 AM

Unsubstantiated


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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/23/2020 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20200623164804
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:0CENSUS: 0DATE:
04/23/2022
UNANNOUNCEDTIME BEGAN:
02:51 PM
MET WITH:Maria LucheroTIME COMPLETED:
03:52 PM
ALLEGATION(S):
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Staff neglect resulted in a resident sustaining multiple pressure injuries
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gary Tan contacted former Licensee Maria Luchero to deliver the findings for the above allegation. LPA made a reasonable attempt to reach the administrator through phone calls and voicemail message but did not get any response. This facility was last visited on 08/13/21 and was informed that they ceased operation since 08/01/21.

During the initial virtual visit 06/24/20 at 1:14 PM, LPA interviewed the administrator and requested copies of facility records relevant to the investigation. LPA also requested Hospice records and hospital records on 06/29/20.

Regarding the allegation that Staff neglect resulted in a resident sustaining multiple pressure injuries, it was alleged that Resident #1 (R1) developed pressure injury at different stages while at the facility.

(continued on LIC 9099)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2022
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 2
Control Number 31-AS-20200623164804
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: STUDIO CITY SENIOR CARE - #1
FACILITY NUMBER: 197608320
VISIT DATE: 04/23/2022
NARRATIVE
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(continued from LIC 9099)

LPA’s record review on 08/13/21 and 03/12/22 revealed R1 was admitted at the facility on 09/24/19 and was admitted for hospice services on 11/20/19. Upon hospice admission, R1 had existing pressure injuries stages 1 & 2 and was being treated by the hospice agency. On 06/07/20, Hospice assessment on R1 revealed that R1 had now a stage 4 pressure injury on Sacro-gluteal area and continued to be treated by the hospice agency. Further record review also revealed that hospice nurses’ visits to R1 increased from twice a week to four (4) times a week beginning the month of May 2020 due to R1’s declining health and to care for the wounds. LPA’s review of the caregiver log documented that R1 was being turned every hour for the month of April until R1’s hospitalization in 06/20/20.

Based on the information gathered during the course of the investigation there is insufficient information that staff neglect resulted to multiple pressure injuries to R1. Therefore, the allegation is deemed unsubstantiated at this time.

Copy of this report is mailed via email and certified mail.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2022
LIC9099 (FAS) - (06/04)
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