197608478-7-14-2023-29-AS-DPEA-CU9TR9-20230731145711

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608478
Report Date: 07/14/2023
Date Signed: 07/14/2023 11:44:02 AM

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
02/17/2023 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20230217110451

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: 70	DATE:	07/14/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Resident Care Director - Diane Guevarra		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Neglect/Lack of Supervision and Care: Resident 1 (R1), sustained a broken foot due to facility staff dropping R1 during a transfer

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Brian Balisi conduced a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA met with Diane Guevarra and explained the reason for the visit.

On 02/17/2023, the Department received a complaint regarding allegations of Neglect/Lack of care and supervision. It was alleged that Resident #1 (R1), sustained a broken foot due to Staff #1 (S1) and Staff #2 (S2) dropping R1 during a transfer while using a Hoyer lift.

On 02/21/2023, from 10:30 a.m. – 12:30 p.m., LPA initiated an unannounced complaint investigation for the allegation listed above. During the visit, LPA toured physical plant, interviewed staff, reviewed, and obtained pertinent documents relevant to the investigation. The complaint was referred to Community Care Licensing Investigations Branch (IB) and assigned to Investigator Lorraine Patterson.

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: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

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 2

Control Number 29-AS-20230217110451

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: 07/14/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from 9099

Investigator Patterson conducted interviews on 03/14/2023, with the complainant/reporting party; on 04/18/2023, from approximately 11:25 a.m. to 11:45 a.m. with Administrator and R1; on 06/15/2023 at approximately 10:51 a.m. with S2 and an attempted interview with S1; on 06/19/2023 with Complainant / reporting party and a potential witness; on 06/20/2023 with Administrator and staff as well as S1. In addition, the investigator reviewed Northridge Hospital Medical Center medical records and facility file documents related to R1.

It was reported that due to neglect/lack of care and supervision, R1 sustained a broken foot, as it was alleged that S1 and S2 dropped R1 during a transfer via a Hoyer lift. Interviews conducted and records reviewed revealed that R1’s family was adamant that staff admitted negligence, which led to dropping R1, however, R1 denied any neglect occurred during the transfer. R1 also reported that they were unsure whether the fracture was a result from the incident or their arthritis. S1 and S2 denied the allegations. S1 and S2, along with management and other staff maintained that prior to lifting R1 via a Hoyer lift that all safety protocols were checked, and that R1’s slip/harness was adjusted. Staff continued to state that R1 began to slip out of the slip/harness while lifting R1, but R1 was caught, and that no part of R1’s body touched the ground. Staff further reported that additional staff was immediately requested and responded to R1’s assigned room to further assist in ensuring R1’s safety.

Based on statements and documentation provided, the Department does not have sufficient evidence to determine that there was negligence or lack of supervision on behalf of the facility staff. While the allegation may be valid, there is insufficient evidence to corroborate that R1 sustained a broken foot due to S1 and S2 dropping R1 during a transfer. Therefore, the allegation that due to Neglect/Lack of Supervision and Care R1 sustained a broken foot is deemed unsubstantiated at this time.

Exit interview conducted and copy of this report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2