197608477-2-22-2022-31-AS-CHAS-CE4TLV-20220504145009

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608477
Report Date: 02/22/2022
Date Signed: 02/22/2022 11:01:54 AM

Substantiated

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
10/07/2021 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20211007154402

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: 60	DATE:	02/22/2022
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Sean Taghizadeh		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Facility did not seek timely medical treatment for resident.

INVESTIGATION FINDINGS:

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On 02/22/22 at 10:35 AM, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent complaint investigation to deliver findings. LPA met with Executive Director and disclosed the reason for the visit.

Regarding the allegation above, it was reported to Community Care Licensing (CCL) on 10/07/2021 that Resident #1 (R1) was admitted to the hospital with left foot cellulitis, wet gangrene, and a wound with maggots on their left foot on 10/06/2021. LPA Reed conducted a 24-hour visit to the facility on 10/08/2021 and acquired resident and facility documents. The allegation was further investigated by Investigations Branch (IB) Investigator Dennis Seng from 10/08/2021 to 01/07/2022.
IB Investigator Seng interviewed staff and residents in person on 10/12/2021 and over the phone on 01/03/2022. Based on information from interviews, staff had difficulty bathing, changing, and performing body checks on R1. R1 had a caregiving team and a wellness team which split duties around R1’s overall health. R1 would often refuse staff assistance and become physically aggressive.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2022

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-20211007154402

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: 02/22/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/23/2022 Section Cited HSC 1569.312(a)	1 2 3 4 5 6 7	§1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least the following basic services (a) Care and supervision as defined in Section 1569.2. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee submited proof of staff and coordinator trainings on resident refusal and medical checks conducted on 11/16/2021, 10/14/2021, and 10/21/2021 to LPA during today's visit. POC cleared.
	8 9 10 11 12 13 14	Based on information obtained through interview and records review, the Licensee did not provide assistance with personal care which endangered the resident's physical health and welfare. This posed an immediate health and sfaety risk to the resident in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20211007154402

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: 02/22/2022

NARRATIVE

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In these cases, staff waited for R1 to calm down and returned to the task. The wellness team was responsible for body checks, yet the team conducted body checks approximately 1 time each month. In the week prior to R1’s hospitalization, R1’s lead caregiver (S1) was on vacation. When S1 returned, they noticed the maggots on R1’s foot and admitted R1 to the hospital that day.

Based on the information obtained from interviews, the above allegation is deemed substantiated at this time.

A $500 immediate civil penalty is assessed today for a violation resulting in injury to R1. The licensee/administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f).

Copy of report issued, civil penalties assessed, appeal rights discussed, and exit interview conducted.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2022

LIC9099 (FAS) - (06/04)

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