197608711-5-6-2024-31-AS-TAGD-D59PRU-20240514113316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608711
Report Date: 05/06/2024
Date Signed: 05/06/2024 02:01:32 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
07/21/2022 and conducted by Evaluator Tuesday Cabiness

COMPLAINT CONTROL NUMBER: 31-AS-20220721101208

FACILITY NAME:	FOOTHILL RETIREMENT CARE HOME		FACILITY NUMBER:	197608711
ADMINISTRATOR:	JINA MALEKSARKISSIANS		FACILITY TYPE:	740
ADDRESS:	6720 SAINT ESTEBAN STREET		TELEPHONE:	(818) 353-3350
CITY:	TUJUNGA	STATE: CA	ZIP CODE:	91042
CAPACITY:	72	CENSUS: 32	DATE:	05/06/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Celia Garcia		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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1. Neglect resulting in infections
2. Failed to follow care plan
3. No hot water
4. Not consulting with responsible party in a timely manner
5. Resident does not have access to bathroom

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit and met with Administrator Celia Garcia. The reason of the visit is to deliver the final findings of the allegations mentioned below. The following was determined:

Allegation # 1: It was alleged facility neglected resident resulting in infections. To conduct the investigation, LPA conducted the initial visit on 07/22/2022. Interviews were conducted and documents were obtained pertaining to the allegations. Due to the facility having a COVID outbreak at that time of the initial visit, LPA was not able to conduct a physical plant inspection, or interview resident # 1 (R1). LPA was able to interview the complainant, and review documents that were provided to LPA. From the interviews and documents, R1 was diagnosed with a fungal infection, and was seen by the podiatrist and a prescription was prescribed to treat the infection. The infection healed, and the prescription was to be continued for prevention measures, as needed (PRN). LPA reviewed R1’s records, and there was no history of infections, and that was the first time. Although it was reported that and alleged that facility staff did not shower or clean R1, interviews conducted

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

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 3

Control Number 31-AS-20220721101208

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: FOOTHILL RETIREMENT CARE HOME	FACILITY NUMBER: 197608711
	VISIT DATE: 05/06/2024

NARRATIVE

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did not corroborate the allegation. During today’s subsequent visit, LPA conducted additional interviews, and conducted a physical plant inspection. Also, it was revealed that R1 was no longer living at the facility, therefore R1 could not be interviewed. Therefore, based on interviews, and documentation reviewed, LPA does not have sufficient evidence to prove the allegation, and it’s Unsubstantiated at this time.

Allegation # 2: It was alleged facility failed to follow care plan. To conduct the investigation, LPA conducted the initial visit on07/22/2022. Interviews were conducted and documents were obtained pertaining to the allegations. Due to the facility having a COVID outbreak at that time of the initial visit, LPA was not able to conduct a physical plant inspection, or interview resident # 1 (R1). Through documentation reviewed, R1 had lived at the facility for several years, and there were no complaints made about staff not providing care for R1. During the pandemic, R1 was not able to regularly be seen by the primary physician but care and supervision was provided by staff during that time. During today’s visit, it was revealed to LPA that R1 no longer lives at the facility, therefore LPA could not interview R1 to obtain further information. Although it was alleged facility did not follow R1’s care plan, based on documentation and interviews, LPA has insufficient evidence to prove the allegation, therefore it’s Unsubstantiated at this time.

Allegation # 3: It was alleged facility had no hot water. To conduct the investigation, LPA conducted the initial visit on 07/22/2022. Interviews were conducted and documents were obtained pertaining to the allegations. Due to the facility having a COVID outbreak at that time of the initial visit, LPA was not able to conduct a physical plant inspection, or interview resident # 1 (R1). During today’s visit, LPA conducted additional interviews and conducted a physical plant inspection of resident’s rooms, as well as measured the hot water temperature. Through the inspection, LPA measured hot water ranged from 105.0 to 111.0 degrees Fahrenheit. It was also alleged that the facility installed a portable sink for R1, but during today’s visit, LPA observed the room to be in normal condition, with a room, bathroom, sink, toilet, and shower. LPA did not observe no portable sink. R1 no longer lives at the facility, therefore LPA could not interview R1 to obtain further information. Therefore, based on observations, the allegation is Unsubstantiated at this time.

Allegation # 4: It was alleged facility did not consult with responsible party in a timely manner. To conduct the investigation, LPA conducted the initial visit on 07/22/2022. Interviews were conducted and documents were obtained pertaining to the allegations. Due to the facility having a COVID outbreak at that time of the initial visit, LPA was not able to conduct a physical plant inspection, or interview resident # 1 (R1).

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20220721101208

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: FOOTHILL RETIREMENT CARE HOME	FACILITY NUMBER: 197608711
	VISIT DATE: 05/06/2024

NARRATIVE

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Through documentation reviewed, it was reported to LPA that the facility installed a portable sink in R1’s room without consulting with R1’s conservator. R1 no longer lives at the facility and LPA was able to inspect R1’s room, and LPA did not observe a portable sink in the room. Although it was reported the facility installed one, during today’s physical plant inspection, LPA did not observe it, and R1 is no longer living at the facility to gather further information. Therefore, based on observations, the allegation is Unsubstantiated at this time.

Allegation # 5: It was alleged resident does not have access to the bathroom. To conduct the investigation, LPA conducted the initial visit on 07/22/2022. Interviews were conducted and documents were obtained pertaining to the allegations. Due to the facility having a COVID outbreak at that time of the initial visit, LPA was not able to conduct a physical plant inspection, or interview resident # 1 (R1). During today’s visit, LPA conducted a physical plant inspection of R1’s former room. LPA took photos, and the room did not appear to be altered or damaged from a wheelchair. Through interviews, it was reported to LPA that R1 did require assistance with toileting, and staff did provide the care. R1 no longer lives at the facility, therefore LPA could not interview R1 to obtain further information. Therefore, based on interviews, the allegation is Unsubstantiated at this time.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

LIC9099 (FAS) - (06/04)

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