197608477-7-30-2021-31-AS-CHAS-C7S2UW-20211013174302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608477
Report Date: 07/30/2021
Date Signed: 07/30/2021 09:50:11 AM

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
02/26/2021 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20210226113834

FACILITY NAME:	SUNRISE ASSISTED LIVING OF STUDIO CITY		FACILITY NUMBER:	197608477
ADMINISTRATOR:	SHAHIN TAGHIZADEH		FACILITY TYPE:	740
ADDRESS:	4610 COLDWATER CANYON		TELEPHONE:	(818) 505-8484
CITY:	STUDIO CITY	STATE: CA	ZIP CODE:	91604
CAPACITY:	121	CENSUS: 61	DATE:	07/30/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Rhoda Bunnin		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Resident sustained multiple fractures
Resident sustained multiple falls while in care

INVESTIGATION FINDINGS:

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An unannounced subsequent complaint visit was conducted on this day by Licensing Program Analyst (LPA) Wendell Smith. Upon arrival LPA met with Rhoda Bunnin (Memory Care Coordinator).

This investigation was conducted by Philippe Miles Investigator with Community Care Licensing Division’s Investigations Branch.
Regarding the allegations listed above, it was alleged that due to lack of proper care and supervision Resident 1 (R1) sustained multiple fractures from multiple falls while living at the facility.
On April 12,2021, the Investigator received a copy of records from Sherman Oaks Hospital which were subpoenaed on 4/6/2021 and reviewed. On 4/19/2021, Investigator Philippe conducted a review of hospital and facility records. Additionally, Investigator Philippe conducted interviews with administrator, various staff members, family of R1, and Primary Care Physician for R1 on various days from 4/12/2021 to 5/13/2021. Records reviewed and interviews conducted revealed the following:

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

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-20210226113834

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: SUNRISE ASSISTED LIVING OF STUDIO CITY	FACILITY NUMBER: 197608477
	VISIT DATE: 07/30/2021

NARRATIVE

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In February 2021, Resident 1 (R1) sustained two (2) unwitnessed falls. The first fall occurred on 2/9/2021, at which time R1 was found on the floor next to her bed. R1 complained of pain and had a bruise on the left shoulder. Facility staff called 9-1-1 and resident was transported to Sherman Oaks Hospital. Hospital records reviewed revealed that R1 sustained a clavicle fracture on the left side of her body. The administrator reported that R1’s care plan has been “adjusted to meet R1’s needs.” The second fall occurred on 2/24/2021, R1 was found on the floor near the memory care entrance door, on her left side 911 was called and resident was transported to Sherman Oaks Hospital. Hospital records reviewed revealed that R1 sustained a fractured hip on the left side of her body that required surgery.

When interviewed, a staff member reported that they “knew for some time” (approximately 6 months from the last appraisal) that R1 required a higher level of care. Other staff members interviewed also confirmed R1 needing a higher level of care due to behavioral and mobility issues.

Facility records reviewed revealed that 6-month assessments were conducted on 7/4/2020, 7/29/2020, and 1/28/2021. The assessments did not document R1 having any behavior or mobility changes. Additionally, facility records didn’t have any updates in R1’s care plan or a completed reappraisal when R1 returned to the facility after the 2/9/2021 fall.
Based on the information obtained, the allegations that resident sustained multiple fractures
and resident sustained multiple falls while in care are substantiated.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 31-AS-20210226113834

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: SUNRISE ASSISTED LIVING OF STUDIO CITY	FACILITY NUMBER: 197608477
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/30/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/02/2021 Section Cited CCR 87463(a)(a)	1 2 3 4 5 6 7	The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Facility shall send a statement that in the future a complete reappraisal will be completed when residents return from the hospital.
	8 9 10 11 12 13 14	Based on records reviewed and interviews conducted by investigator Philipe which revealed that licensee/administrator failed to document changes in R1’s condition and complete a reappraisal after hospitalization which posed an immediate risk to residents in care.	8 9 10 11 12 13 14
Type A 08/02/2021 Section Cited CCR 87468	1 2 3 4 5 6 7	Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Facility shall send statement to address this citation and how to ensure it does not happen in the future.
	8 9 10 11 12 13 14	Based on records reviewed and interviews conducted by investigator Philipe which revealed that Staff observed the loss and deterioration of R1’s mental and physical ability but failed to insure appropriate care was provided to meet those needs resulting in R1 sustaining fractures which posed an immediate risk to residents in care.	8 9 10 11 12 13 14

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: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

LIC9099 (FAS) - (06/04)

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