197608745-5-21-2022-31-AS-CHAS-CEY2AD-20220531171321

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608745
Report Date: 05/21/2022
Date Signed: 05/21/2022 11:28:14 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/02/2021 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20210402132849

FACILITY NAME:	PARADISE SENIOR LIVING -1		FACILITY NUMBER:	197608745
ADMINISTRATOR:	ANGELA ANGLE APOYAN		FACILITY TYPE:	740
ADDRESS:	8435 AURA AVENUE		TELEPHONE:	(818) 626-3338
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91324
CAPACITY:	6	CENSUS: 6	DATE:	05/21/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Vanisa Campbell		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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1. Staff digitally penetrated resident's private area
2. Staff inappropriately touched resident
3. Staff mismanage resident's medication
4. Staff yells and screams at resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness met with caregiver Vanisa Campbell and informed her the reason of the visit. Administrator Angela Apoyan was contact and also informed the reason of the visit. The visit was to to finalize the above complaint allegations. On April 02, 2021, the Woodland Hills Regional South Adult and Senior Care Office received a complaint for the allegations mentioned above. On April 12, 2021, the complaint was referred to the Community Care Licensing Division’s (CCLD’s) Investigations Branch (IB) and assigned to Investigator Dennis Seng, who determined the following for allegations 1 & 2:

Allegation #1: Staff digitally penetrated resident’s private area: Concerns were expressed “Staff digitally penetrated resident’s private area”. On April 08, 2021, from 830am to 12pm, LPA Jose Gary Tan conducted the initial complaint visit, and obtained facility and resident documents, as well as conducted interviews with staff and residents. Investigator Dennis

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022

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-20210402132849

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: PARADISE SENIOR LIVING -1	FACILITY NUMBER: 197608745
	VISIT DATE: 05/21/2022

NARRATIVE

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Seng conducted interviews, obtained, and reviewed facility documents and medical recordspertaining to the complaint, on 06/01/2021, 06/09/2021, 06/15/2021, 06/29/2021, and 06/30/2021. The following is a summary of the IB investigation finding of the allegation. Interviews revealed that resident # 1 (R1) has had a history of fabricating allegations and was recently being difficult with staff while residing at the facility. It was also reported that R1 treated African American staff with hostility more than other staff from different ethnicities and would create a difficult work environment for staff # 1 (S1) who was the alleged suspect in the complaint. It was also reported that R1 would yell and call names toward S1. S1 denied the allegation and the investigation revealed through interviews conducted that there were no witnesses that could corroborate the allegation, “Staff digitally penetrated resident’s private area”. Therefore, based on the investigation conducted by IB investigator Dennis Seng, and all information obtained through interviews, the allegation is deemed UNSUBSTANTIATED at this time.

Allegation # 2: Staff inappropriately touched resident: Concerns were expressed that “Staff inappropriately touched resident.” On April 08, 2021, from 830am to 12pm, LPA Jose Gary Tan conducted the initial complaint visit and obtained facility and resident documents; as well as conducted interviews with staff and residents. Investigator Seng conducted interviews, obtained, and reviewed facility documents and medical records, pertaining to the complaint, on 06/01/2021, 06/09/2021, 06/15/2021, 06/29/2021, and 06/30/2021. The following is a summary of the IB investigation finding of the allegation. Interviews revealed that resident # 1 (R1) has had a history of fabricating allegations, and was recently being difficult with staff, while residing at the facility. It was also reported that R1 treated African American staff with hostility more than other staff from different ethnicities and would create a difficult work environment for staff # 1 (S1) who was the alleged suspect in the complaint. Interviews revealed that S1 denied touching R1 inappropriately and there were no witnesses that could corroborate the allegation, “Staff inappropriately touched resident”. Therefore, based on the investigation conducted by IB investigator Dennis Seng, and all information obtained through interviews, the allegation is deemed UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20210402132849

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: PARADISE SENIOR LIVING -1	FACILITY NUMBER: 197608745
	VISIT DATE: 05/21/2022

NARRATIVE

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Allegation # 3: Staff mismanage resident’s medication: Concerns were expressed “Staff inappropriately touched resident. On April 08, 2021, from 830am to 12pm, LPA Jose Gary Tan, conducted the initial complaint visit, and obtained facility and resident documents; as well as conducted interviews with staff and residents. LPA Tuesday Cabiness conducted record review on April 07, 2021, September 16, 2021, October 09, 2021 and October 16 & 17, 2021, from various times, from 8am to 4pm. Information revealed, resident # 1 (R1) was receiving hospice services and medication management was provided; and nurses visited R1 twice a week, where medication was assessed each visit. It was also reported from facility documentation, on specific dates, R1 accepted and refused medication provided by facility staff. LPA interviewed facility staff on 09/16/2021 at 130pm, who handles resident’s medication, who reported to LPA, that all medications for R1 and other residents are administered according to physician orders. LPA was not able to interview R1, due to R1 relocating to another facility. Therefore, based on facility and medical/hospice documentation, LPA has insufficient evidence to prove “Staff mismanage resident’s medication”, therefore the allegation is UNSUBSTANTIATED at this time.

Allegation # 4: Staff yells and screams at resident in care: Concerns were expressed “Staff yells and screams at resident in care”. On April 08, 2021, from 830am to 12pm, LPA Jose Gary Tan, conducted the initial complaint visit, and obtained facility and resident documents; as well as conducted interviews with staff and residents. LPA Tuesday Cabiness reviewed documents on April 07, 2021, September 16, 2021, October 09, 2021 and October 16 & 17, 2021, from various times, from 8am to 4pm. According to information obtained, residents reported they have never witnessed any staff yell or scream at them; nor have they witnessed staff yell or scream at other residents. Residents reported they were happy at the facility, and staff were respectful and caring. LPA was not able to interview R1, due to R1 relocating to another facility. Therefore, based on interviews, LPA could not prove “Staff yell and scream at residents in care”, and at this time, the allegation is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022

LIC9099 (FAS) - (06/04)

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