197608477-4-19-2023-31-AS-MVAO-CR8PFC-20230425111629

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608477
Report Date: 04/19/2023
Date Signed: 04/19/2023 12:25:15 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/22/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20220222144340

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: 71	DATE:	04/19/2023
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Sean Taghizadeh		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Resident sustained unexplained injuries while in care
Staff did not seek timely medical care
Authorized representative was not notified

INVESTIGATION FINDINGS:

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At 10:15 a.m. on 04/19/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent visit. LPA met with the Administrator and disclosed the reason for the visit.

Regarding the allegation “Resident sustained unexplained injuries while in care”, it was alleged staff were unaware of Resident #1’s (R1) injuries on 11/09/2021. LPA interviewed facility staff between 10:20 a.m. and 11:30 a.m. and conducted a record review at 11:30 a.m. on 04/19/2023. Information from interviews revealed R1 fell from their bed around 11:00 a.m. after reaching for their walker. R1 used their medical pendant and Staff #1 (S1) and another staff member responded to R1’s call for help. S1 assessed R1 for pain and performed a full body scan. R1 did not report pain and S1 did not observe any sign of injury. The two staff assisted R1 back to bed and monitored R1 for any changes every 1 – 2 hours thereafter. Later that day, progress notes indicated that R1 was observed on their knees in the bathroom at 3:54 p.m. R1 then reported pain in their left hip. Staff notified responsible parties and re-assessed R1.

Unsubstantiated

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: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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-20220222144340

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: 04/19/2023

NARRATIVE

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LPA reviewed additional records at 4:00 p.m. on 02/25/2022. Records revealed R1 had a history of falls. The facility ordered physical therapy to address R1’s unsteady gait. Records also indicated that R1 was able to communicate their needs and frequently notified staff of their falls. Based on interviews and record review, staff properly monitored R1 for any health changes and were aware of R1’s injuries. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff did not seek timely medical care”, it was alleged staff delayed seeking medical treatment for R1’s injuries from 11/09/2021. From interviews, S1 stated R1 refused medical treatment after the fall out of bed. Progress notes showed that R1 later reported leg pain and requested pain medication at 11:35 a.m. and 1:52 p.m. The PRN medication supplied was deemed effective for managing R1’s pain. After R1 reported hip pain at 3:54 p.m., R1 requested anxiety medication which the facility assisted with at 5:01 p.m. The facility notified responsible parties of R1’s pain and called for medical transportation. R1 was taken to Sherman Oaks Hospital by 5:08 p.m. Based on interviews and record reviews, the facility staff offered and provided medical care in a timely manner for R1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Authorized representative was not notified”, it was alleged the facility did not inform R1’s responsible person of R1’s fall incident. During a phone interview on 02/25/2022 at 3:30 p.m., R1’s responsible person verbally confirmed they received a phone call from the facility at 11:38 a.m. on 11/09/2021 to report the incident. R1’s responsible person also provided photographic proof of the missed call. Record review also indicated that R1's responsible person was notified after each report of pain. Based on interview and photo review, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided. Appeal rights discussed.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC9099 (FAS) - (06/04)

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