197608745-5-21-2022-31-AS-CHAS-CGGU2D-20220719151142

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608745
Report Date: 05/21/2022
Date Signed: 05/21/2022 11:12:06 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
04/07/2021 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20210407092838

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:	10:30 AM
MET WITH:	Vanisa Campbell		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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1. Facility staff handled resident roughly
2. Facility staff left resident in soiled diaper for long periods
3. Facility staff refuses to transfer client to wheelchair
4. Facility mismanaged resident's funds

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness met with caregiver Vanisa Campbell, who was informed the reason of the visit. Administrator Angela Apoyan was contacted, and also informed the reason of the visit. The following was determined:

Allegation # 1: It was alleged that facility staff handled resident roughly. 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 and conducted interviews 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, R1 had a history of fabricating and making up stories against staff, who R1 did not personally like. Interviews conducted revealed, that R1 had previously alleged abuse by S1, in which the investigation was

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: 05/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2022

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-20210407092838

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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determined to be unsubstantiated. It was also revealed from other residents, they have never witnessed or heard staff mishandling R1, and that R1 was difficult and mean toward S1. LPA could not interview R1, due to R1 relocating to another facility. Therefore, based on information obtained through interviews and documents, LPA could not find sufficient evidence to prove “Facility staff handled resident roughly”, and the allegation is UNSUBSTANTIATED at this time.

Allegation # 2: Facility staff left resident in soiled diaper for long periods. It was alleged that facility staff left resident in soiled diapers for long periods. 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 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. Interviews revealed, that R1 was non-ambulatory, and needed assisted with continent care. Staff reported that R1 would be changed every (2) hours and was never left in soiled diapers. Interviews from other residents reported to LPA, that staff changes their diapers. LPA could not interview R1, due to R1 relocating to another facility. Therefore, based on information obtained through interviews and documents, LPA could not find sufficient evidence to prove “Facility staff left resident in soiled diapers for long periods” and the allegation is UNSUBSTANTIATED at this time.

Allegation # 3: Facility staff refuses to transfer client to wheelchair. It was alleged that facility staff left resident in soiled diapers for long periods. 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 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. According to documents reviewed, R1 was non-ambulatory and required assistance to be transferred to a wheelchair. Interviews

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2022

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20210407092838

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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conducted with staff, reported, they always assisted R1 when R1 wanted to be in the wheelchair. Staff also reported, R1 at times did not want to be in R1’s wheelchair; and staff assisted when needed. Although it was reported staff refused to transfer R1 to wheelchair, LPA could not interview R1 due to R1 relocating to another facility. Therefore, LPA could not find sufficient evidence to prove “Facility staff refuses to transfer client to wheelchair”, and based on information obtained through interviews and documents, the allegation is UNSUBSTANTIATED at this time.

Allegation # 4: Facility mismanaged resident's funds. It was alleged that facility mismanaged resident’s funds. 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 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. According to documentation reviewed, it was revealed that R1 did not pay rent and gave the Administrator a check for rent, in which it was returned for non-sufficient funds. Administrator reported to LPA, that was not the first time, R1 did not pay rent, and gave her a “bad check”. LPA could not interview R1, due to R1 relocating to another facility. Therefore there based on interviews and documentation, there is not sufficient evidence to prove, “Facility mismanaged resident’s funds”, and the allegation is 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: 05/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2022

LIC9099 (FAS) - (06/04)

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