197608478-2-28-2024-29-AS-DPEA-D2WVK2-20240229152937

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608478
Report Date: 02/28/2024
Date Signed: 02/28/2024 03:30:35 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/28/2022 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20221128082245

FACILITY NAME:	SUNRISE ASSISTED LIVING OF WOODLAND HILLS		FACILITY NUMBER:	197608478
ADMINISTRATOR:	PATRICE O'GRADY		FACILITY TYPE:	740
ADDRESS:	20461 VENTURA BLVD		TELEPHONE:	(818) 346-9046
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY:	127	CENSUS: 64	DATE:	02/28/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Patrice O'Grady		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Resident sustained injuries while in care

Staff failed to keep resident's room clean

Facility refused resident's POA vistation at facility

Facility failed to follow resident's diet plan

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to deliver final findings of the allegations listed above. During today’s visit, LPA met with Patrice O'Grady and explained the reason for the visit.

On 11/29/2022, from 09:30 a.m. – 4:30 p.m., LPA initiated an unannounced complaint investigation for the allegations listed above. During the visit, LPA toured the physical plant, interviewed staff, residents and reviewed and obtained pertinent documents relevant to the investigation. On 02/02/2024, from 10:30 a.m. – 3:00 p.m., LPA conducted a subsequent complaint visit. During the visit, LPA toured physical plant, interviewed staff as well as reviewed and obtained copies of additional documentation relevant to the investigation.
It was reported that Resident #1 (R1) sustained injuries while in care, as it was alleged that R1 was observed with bruises and cuts on left arm due to staff neglect. Interviews conducted and records reviewed reflected that on 10/18/2022, facility staff observed some swelling on R1's left arm

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 29-AS-20221128082245

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: SUNRISE ASSISTED LIVING OF WOODLAND HILLS	FACILITY NUMBER: 197608478
	VISIT DATE: 02/28/2024

NARRATIVE

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Continued from 9099
The Power of Attorney (POA) of R1 was informed and verbalized to staff that they will take R1 to the hospital. On 10/19/2022, R1 returned to the community. On 10/22/2022, the POA provided staff with a hospital discharge summary that advised that R1 should exercise the arm to avoid swelling. On 10/28/2022, the POA admitted R1 into urgent care due to a sore throat. On 10/29/2022, R1 returned to the facility with instructions from the MD to test for blood clot for the left arm swelling. The POA stated they will take R1 to hospital for testing. On 11/14/2022, was observed with a skin tear on the left arm and first aid was provided. The MD and POA were informed. In addition, LPA’s interview with Resident Care Director (RCD) revealed, R1 had sensitive skin. R1 had some small skin tears, which may have come from rubbing against their clothes, rubbing against a wall or other hard surface. When skin tears are observed they apply a topical solution. If any of the tears drew blood, dried up, scabbed it may be observed to look like a cut. RCD continued to state the arm began to swell up and bruise early in October and the POA was aware. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “R1 sustained injuries while in care” is deemed Unsubstantiated at this time.

It was reported that staff failed to keep resident's room clean, as it was alleged fecal excrement was observed in abundance on R1's toilet seat and trash can. Interviews conducted with eleven (11) staff revealed that ten (10) out of the eleven (11) staff stated they have never observed fecal excrement in abundance on R1's toilet seat or trash can. The one staff who did observe the details above, was Staff # (S1) who stated that one day the POA informed S1, that R1's bathroom needed some attention. S1 went to R1's room as soon as they were informed, and replaced the plastic bag in the trash can with a new one. S1 did not observe trash can overflowing with toilet paper, there was no toilet paper in the surrounding area around the trash and S1 was able to pull up the plastic bag and tie it up without pushing it down. S1 continued to state they did not observe any fecal excrement on the toilet seat, however if that was ever observed, staff would clean it themselves or request housekeeping to conduct a deep clean if the fecal excrement was heavy. In addition, LPA's interview with eight (8) family members / responsible parties of residents currently in care revealed that all eight (8) did not express any potential or immediate concerns that staff would not keep resident’s bathroom clean. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20221128082245

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: SUNRISE ASSISTED LIVING OF WOODLAND HILLS	FACILITY NUMBER: 197608478
	VISIT DATE: 02/28/2024

NARRATIVE

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Continued from 9099-C

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff failed to keep resident’s room clean” is deemed Unsubstantiated at this time.

It was also reported that facility refuses resident's POA visitation at facility, as it was alleged that the POA was given a written notice, which stated that the POA is no longer allowed to visit Resident #1 (R1) in the facility. Interviews conducted and records review revealed that R1’s POA did in fact receive a written notification on 11/15/2022, which stated that R1’s POA is not allowed to conduct visits inside the facility, due to R1’s POA having violated multiple house rules, along with multiple incidents involving R1’s POA and various staff that have threatened the health, safety and personal rights of staff and residents in care. In the investigation further revealed that even though the facility issued the letter to R1’s POA, the POA visited multiple times after. Moreover, records reflected that the admission agreement signed by the POA on 08/24/2022 indicates the following “Article II Section N “ The Resident and Responsible party understand and agree that the Executive Director or designee may restrict an individual’s visitation rights or bar an individual from entering the Community if it is determined that the individual is disrupting the care of the Resident, the care of other residents, or if the presence of the individual has a negative effect on a resident’s physical or psychosocial well-being.” The investigation further reflected that the facility did not refuse visitation however, put parameters around the visitation such as advance notice and outdoor visits in order to maintain a healthy environment. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “facility refused resident's POA visitation at facility” is deemed Unsubstantiated at this time.

It was reported that the facility failed to follow resident’s diet plan, as it was alleged that R1 is on a “special diet plan”, but staff are not following it. Interviews conducted and records review revealed that R1 had a physician’s order to be on a pureed diet. A third-party company provides this facility their pureed foods to ensure it is blended properly and sanitary, however R1’s POA was witnessed by staff multiple times attempting to feed R1 food served from the kitchen that are not blended to a pureed texture along with multiple attempts to provide R1 food from surrounding restaurants.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20221128082245

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: SUNRISE ASSISTED LIVING OF WOODLAND HILLS	FACILITY NUMBER: 197608478
	VISIT DATE: 02/28/2024

NARRATIVE

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Continued from 9099-C

Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “facility failed to follow resident’s diet plan” is deemed Unsubstantiated at this time.

Exit interview conducted/No citations issues/ A copy of report was provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC9099 (FAS) - (06/04)

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