197608466-6-15-2021-29-AS-JAPL-C8M23P-20211109160241

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608466
Report Date: 06/15/2021
Date Signed: 06/15/2021 01:23:36 PM

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
03/12/2021 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20210312152328

FACILITY NAME:	BELMONT VILLAGE ENCINO		FACILITY NUMBER:	197608466
ADMINISTRATOR:	DRACHENBERG, CYNTIA		FACILITY TYPE:	740
ADDRESS:	15451 VENTURA BLVD		TELEPHONE:	(818) 788-8870
CITY:	SHERMAN OAKS	STATE: CA	ZIP CODE:	91403
CAPACITY:	150	CENSUS: 107	DATE:	06/15/2021
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Cyntia Drachenberg		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Failure to provide personal assistance and care to residents as needed
Failure to provide a daily diet of the quantity necessary to meet resident’s needs
Failure to maintain the facility in a clean and sanitary condition at all times.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Ashley Smith and Sandra Urena arrived at 8:30 am for an unannounced subsequent complaint visit to investigate the above allegations. The LPAs met with Administrator Cyntia Drachenberg and informed them for the reason of the visit.

During the initial virtual visit on 3/22/2021, LPA Eva Miller conducted interviews with staff and requested records from 1:15 pm to 2:30 pm. During today’s visit, the LPAs conducted a physical plant tour at 9:45 am, interviewed staff and conducted additional observations in the memory care unit from 11:17 am – 11:50 am.

Regarding the allegation: Failure to provide personal assistance and care to residents as needed
It was alleged that the residents in the memory care unit were being neglected and were not being cleaned. Interviews conducted confirmed that residents were provided with assistance as described in their care plan, which could include assistance with bathing, dressing, eating, grooming, and other activities of daily living.

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: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

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 29-AS-20210312152328

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: 06/15/2021

NARRATIVE

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During today’s visit, the LPA observed residents receiving assistance from staff for a variety of needs. The LPA observed staff assisting residents with utilizing hand sanitizer prior to mealtime, staff were observed escorting residents to mealtime, staff assisted with grooming needs, and so forth. Throughout the observation period and the physical plant tour, residents appeared clean and well kept. Based on the investigation, there is insufficient evidence to support the claim that staff failed to provide personal assistance and care to residents as needed. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Failure to provide a daily diet of the quantity necessary to meet resident’s needs
It was alleged that residents were not provided with food, particularly the residents in the memory care unit. Interviews conducted confirmed that all residents are provided with a minimum of three meals a day, along with snacks in between. During today’s visit, the LPAs observed lunch service for both the assisted living and memory care residents. Specifically, in the memory care unit, the LPA observe staff assisting residents at mealtime, and the meal was of sufficient quality and variety of food. The LPAs observed that resident dietary preferences and special diets were maintained. The LPAs did not observe food that was expired, of poor quality, or in poor condition. Facility menus were also reviewed, in which the options change weekly, and the menus are nutritionally balanced with varied options to meet all dietary needs and preferences. Based on the investigation, there is insufficient evidence to support the claim that staff failed to provide a daily diet of the quantity necessary to meet resident’s needs. This allegation is Unsubstantiated at this time.

Regarding the allegation: Failure to maintain the facility in a clean and sanitary condition at all times.
It was alleged that all the rooms in the memory care unit were malodorous. During today’s visit, the LPAs conducted a tour of the facility starting at 9:45 am, and additional observations in the memory care unit from 11:17 am – 11:50 am. The LPAs looked in randomly selected rooms and did not smell any odors or observe any soiled furniture. Residents also appeared clean and well kept. Interviews with the Administrator and Building Manager confirmed that the facility is cleaned and sanitized throughout the day. Based on the investigation, there is there is insufficient evidence to support the claim that staff failed to maintain the facility in a clean and sanitary condition. This allegation is Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted. A copy of the report was issued .

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC9099 (FAS) - (06/04)

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