197608611-8-2-2022-31-AS-NMAN-CHE2U4-20220817174143

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608611
Report Date: 08/02/2022
Date Signed: 08/02/2022 05:06:55 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
03/18/2022 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20220318131130

FACILITY NAME:	ESTAR RESIDENTIAL CARE		FACILITY NUMBER:	197608611
ADMINISTRATOR:	ARNALDO A. HUKOM		FACILITY TYPE:	740
ADDRESS:	8559 BOTHWELL ROAD		TELEPHONE:	(818) 727-1953
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91324
CAPACITY:	6	CENSUS: 4	DATE:	08/02/2022
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Arnaldo Humkom		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff will not allow the resident to get out of bed.

Staff make personal calls in the room with the resident.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Lynn Smith made an unannounced complaint visit to this facility at 9:10 am. LPA Smith was greeted by facility staff, Pamela Joaquin and Art Villafuerte, who took LPA's temperature upon entry. LPA informed staff the purpose of this visit. The administrator was called and arrived later.

During initial visit, on 03/22/22, LPA Smith conducted physical plant tour at 11:15 AM, requested facility documents relevant to the investigation at 12:30 AM and interviewed staff, and three (03) put of four (04) residents between 11:45 AM to 2:30 PM. During today's visit LPA conducted physical plant tour at 11:50 am facility, greeted (R1) observed sitting in living room, and requested pertinent documents. At 3:30 pm LPA also observed and greeted (R2) walking around facility with the aid of their walker.

Staff will not allow the resident to get out of bed.
It was alleged that staff will not allow the resident to get out of bed. LPA Smith’s interview with the two Non-
(Cont to 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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 31-AS-20220318131130

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: ESTAR RESIDENTIAL CARE	FACILITY NUMBER: 197608611
	VISIT DATE: 08/02/2022

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

(Cont from 9099)

ambulatory residents; Resident #1 (R1) Resident #2 (R2) revealed that staff periodically engage resident and
inquire if they want to sit in the living room or out on patio for activities. R1 also revealed they enjoy sitting in the living room so they can look out at the scenery from the living room. R2 revealed staff will ask if prefer to eat meal in room or in living room and staff provides assistance getting out of bed and with walker to go sit in living room and/or patio. LPAs’ interview with staff revealed that staff routinely assists residents with daily mobility after resident verbally verify they are physically feeling up to getting out of bed to spend time in living room or outdoors under covered patio. During today’s LPA observed R1 sitting on the couch in the living room looking out of patio sliding glass door.

Based on the information gathered during previous licensing visit, and at the time of this visit, there is lack of pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Staff make personal calls in the room with the resident.

It was alleged that staff make personal calls in the room with the resident. LPA Smith’s interview with three (03) out of four (04) residents revealed that staff do not come into their rooms to make phone calls. LPAs interview with staff revealed that staff periodically walk around the facility with house phone doing facility checks with administrator over phone but otherwise do not disturb the residents when they are in their rooms.

Based on the information gathered during previous licensing visit, and at the time of this visit, there is lack of pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted and copy of report printed.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2