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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608466
Report Date: 09/27/2022
Date Signed: 09/27/2022 06:08:49 PM

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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/20/2022 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20220420114242
FACILITY NAME:BELMONT VILLAGE ENCINOFACILITY NUMBER:
197608466
ADMINISTRATOR:DRACHENBERG, CYNTIAFACILITY TYPE:
740
ADDRESS:15451 VENTURA BLVDTELEPHONE:
(818) 788-8870
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY:150CENSUS: 106DATE:
09/27/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ralph BalbinTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility does not have adequate staffing to meet the needs of the residents.
Resident's grooming needs are not being met.
Resident's medical needs are not being met.
Resident is not treated with respect.
Residents are not provided with activities.
Staff handle residents in a rough manner.
INVESTIGATION FINDINGS:
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On 09/27/2022, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent visit to address the above allegations. LPA Urena met with Executive Director (ED), Ralph Balbin at 10:30 a.m., and explained the reason for the visit. The LPA conducted additional residents' interviews from 11:35 a.m., to 12:15 p.m.

On 04/26/2022, Licensing program Analyst (LPA) Sandra Urena conducted an initial 10-day unannounced visit to investigate the allegations named above. LPA Urena arrived at the facility at 10:25 a.m., and met with Executive Director (ED) Ralph Balbin, and explained the reason for the visit. At 10:45 a.m., the LPA, and the ED conducted a brief tour of the facility. The LPA interviewed staff and residents from 11:37 a.m. to 3:30 p.m., and conducted record review.

Continues on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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 4
Control Number 29-AS-20220420114242
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: BELMONT VILLAGE ENCINO
FACILITY NUMBER: 197608466
VISIT DATE: 09/27/2022
NARRATIVE
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It is alleged that the ‘Facility does not have adequate staffing to meet the needs of the residents.’ The concern of the Reporting Party (RP) is that the facility does not have enough staff to meet the needs of residents, specifically in the memory care unit (neighborhood). To investigate this concern, LPA Urena conducted record review of staff schedules, and conducted interviews with staff, and residents. The record review revealed that the facility has three shifts of staff throughout the 24 hour period. The ratio of staff to residents is 6:1. Residents in the memory care unit were unable to coherently answer the LPA’s questions, consequently, the residents’ interviews were done with residents living in the assisted living community. Residents stated, ‘that staff go out of their way to assist residents; there is enough staff to take care of our needs’. The staff’s interviews revealed that the staff communicate with each other, between shifts through a get-together meeting called a ‘crossover’ of shifts. During the ‘crossover’, staff communicate with each other about the residents’ daily needs. Furthermore, the staff’s interviews revealed that the staff have specific assigned daily duties to care for the residents residing in the memory care units. Based on the information gathered, and interviews conducted, the facility appears to have enough designated staff to meet the needs of the residents. Therefore, the allegation that the 'Facility does not have adequate staffing to meet the needs of the residents', is deemed Unsubstantiated at this time.

It is alleged that ‘Resident's grooming needs are not being met’. The concern of the RP is that the R1 is not being assisted by staff with showering, and brushing their teeth. If R1 refuses grooming services, the staff does not make additional attempts to provide these services. To investigate this concern, LPA Urena interviewed staff, and residents. The LPA interviewed R1 about their grooming needs being met, and if assistance was needed for grooming? R1 stated that they are not a child, and if they want to take shower they will, and does not like being insisted on taking showers. They like to dress well, and has always dressed well. RI stated that they 'do not need assistance for grooming'. The LPA interviewed nine staff about the grooming needs of residents. The staff stated that they encourage residents to take a shower, and get groomed by telling the residents that they will have family visitors. Additionally, staff stated that the residents are assisted (if needed) with brushing their teeth, brushing hair, and getting dressed before going to breakfast in dining area. The staff stated that showers for residents are also as per the request of the family members/responsible parties. Staff reported that if a resident refuses to take a shower, the nurse is informed of the situation to help address the grooming issues of the residents. The staff and residents’ interviews revealed that residents grooming needs are being met. Based on the interviews, the allegation that Resident's grooming needs are not being met, is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20220420114242
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: BELMONT VILLAGE ENCINO
FACILITY NUMBER: 197608466
VISIT DATE: 09/27/2022
NARRATIVE
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It is alleged that ‘Resident's medical needs are not being met’. The concern of the RP is that R1 needs to be receiving occupational and physical therapy, but staff have not set up the services yet. To investigate this concern, LPA Urena conducted record review, and interviewed staff. Record review revealed that R1 resided for a few months at the facility. Additionally, the record review revealed that R1’s primary physician changed at least three different times since the date of R1’s admission in the facility, and per the request of R1’s RP. Record review revealed that R1’s RP declined a follow-up physician’s appointment in March 2022. The R1’s Physician’s Report does not indicate that R1 needs any type of therapy. Based on the observations, interviews, and information gathered, R1 was receiving medications as needed, and prescribed. Therefore, the allegation that ‘residents’ medical needs are not being met’, is deemed Unsubstantiated at this time.

It is alleged that the ‘Resident is not treated with respect’. The concern of the RP is that staff do not listen to R1; staff "ignore" R1. RP stated that staff speak Spanish, but they understand R1. The RP reported that when R1 asks staff for something, they don't acknowledge R1 and ignore their requests. The LPA interviewed R1 to ask about the communication with staff. R1 stated that staff understand when they are speaking to them, ‘sometimes it takes them awhile to respond, or bring what I want. I don’t feel that they are disrespectful’. The LPA attempted to interview other residents in the memory care unit, but residents were unresponsive to the questions. The LPA interviewed residents in the assisted living unit. The residents’ interviews revealed that staff are courteous, responsive to their needs, and friendly. Although some staff may speak Spanish, they also speak, and understand English. Based on the observations, and the interviews, the residents are treated with respect. Therefore, the allegation that ‘Resident is not treated with respect’, is deemed Unsubstantiated at this time.

Continues on LIC 9099-C...

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20220420114242
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: BELMONT VILLAGE ENCINO
FACILITY NUMBER: 197608466
VISIT DATE: 09/27/2022
NARRATIVE
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It is alleged that the ‘Residents are not provided with activities. The concern of the RP is that the R1 does not have activities; R1 sits, and watches television all day. To investigate this concern, LPA Urena conducted staff interviews, record review, and observed activity sessions. The LPA reviewed the April Activities Calendar for the memory care units, and observed activities being presented to residents on the day of the visit. The LPA observed residents being presented with interactive activities, however due to the residents’ mental status, the residents were not fully engaged. The LPA interviewed staff about the activities being presented to residents: How are the activities developed, and are residents’ needs being taken into account when the activities are created? The staff reported that the activities presented to residents come directly from the corporate office. The activities are designed for cognitive, and physical stimulation. The activities are broken into three separate types of activities: 1) AM-Cognitive, 2) Hands-on (fine motor), and 3) Physical Activities (large motor). Per the Activities Calendar, each day has a topic/theme of the day. On 04/26/2022, the LPA observed the ‘National Bird Day’ activity being presented to the residents. Based on the information gathered and observations, the residents are being provided with activities that are designed to stimulate the residents' cognitive, and physical needs. Therefore, the allegation that Residents are not provided with activities, is deemed Unsubstantiated at this time.

It is alleged that ‘Staff handle residents in a rough manner’. The concern of the RP is that some of the staff handle residents in a rough manner. RP stated that staff are rough when assisting residents into the wheelchairs as well as taking them out of the wheelchairs. To investigate this concern, LPA Urena attempted to interview residents in the memory care unit, however the residents interviewed were not responsive to the LPA’s questions. At 11:55 a.m., in the main dining room (first floor)for assisted living residents, the LPA observed residents sitting in their wheelchairs while having lunch. The LPA was not able to observe staff transfer residents from the wheelchair to another chair, however the LPA did interview residents that were sitting in wheelchairs while eating lunch at table. The residents stated that staff are gentle, and careful when assisting them in and out of the wheelchairs. The staff interviewed stated that they are careful when transferring residents in and out of the wheelchairs, and understand that the residents’ skin is fragile. Based on the interviews, staff assist residents in wheelchairs with care, are gentle, and careful while transferring them in and out of their wheelchairs. Therefore, the allegation that ‘Staff handle residents in a rough manner’, is deemed Unsubstantiated at this time.
Exit interview was conducted with the facility representative, signatures were obtained, and a copy of the report was issued.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4