197608477-6-14-2023-31-AS-NMAN-CSTUUD-20230615155323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608477
Report Date: 06/14/2023
Date Signed: 06/14/2023 04:27:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
03/21/2023 and conducted by Evaluator Antonia Alvizar

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230321120829

FACILITY NAME:	SUNRISE ASSISTED LIVING OF STUDIO CITY		FACILITY NUMBER:	197608477
ADMINISTRATOR:	SHAHIN TAGHIZADEH		FACILITY TYPE:	740
ADDRESS:	4610 COLDWATER CANYON AVE		TELEPHONE:	(818) 505-8484
CITY:	STUDIO CITY	STATE: CA	ZIP CODE:	91604
CAPACITY:	121	CENSUS: 65	DATE:	06/14/2023
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:			TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Staff neglect to clean resident's wound as required
Staff did not ensure resident's hygiene needs are being met

INVESTIGATION FINDINGS:

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Licensing Program Analyst LPA Alvizar conducted a subsequent visit to the facility to complete investigation initiated on 03/22/2023. LPA met with ED and explained the purpose of this visit.

Staff neglect to clean resident's wounds as required
It was alleged that resident#1 (R1) has blisters on his legs or foot from edema that is open and not being cleaned by the staff.

During initial visit at 10:30am, LPA inspected the facility and spoke with 3 out of 4 randomly selected residents. Between 11:10am to 1:00pm, LPA spoke with facility staff. At 1:40pm, LPA gathered facility records, that were reviewed on 03/24/23.

At the time of initial visit LPA attempted to interview resident #1 (R1) and they refused to be interviewed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

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-20230321120829

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNRISE ASSISTED LIVING OF STUDIO CITY	FACILITY NUMBER: 197608477
	VISIT DATE: 06/14/2023

NARRATIVE

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Staff indicated that R1 has Edema and is receiving care from Home Health Nurses. R1 does not have blisters on their legs. R1 frequently scratches their legs, resulting skin tears. As per R1’s request, some time staff helps R1, by cleaning their legs and applying ointment. Staff also revealed that R1 wants to hold independence, therefore refuses care when offered.

A review of facility records verified the information revealed from staff. Based on observation, interviews and record review, there is no sufficient information to verify the allegation. Therefore, the allegation is Unsubstantiated at this time.

Staff did not ensure resident's hygiene needs are being met
It was alleged that resident #1 (R1) has poor hygiene.

Staff interviews revealed that R1 does not required hygiene assistance and is able to dress and bathe themselves. When staff is approaching R1 for assistance, they refuse to get assistance.
At the time of initial visit LPA Alvizar observed and assessed R1. Resident did not have poor hygiene and did not appear needing hygiene assistance.

The information revealed from facility records verified the information received from the staff.
Based on observation, interviews and record review, there is an insufficient information to support the allegations. Therefore, the allegation is deemed unsubstantiated at this time.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

LIC9099 (FAS) - (06/04)

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