197608907-9-26-2023-31-AS-NMAN-CZERE9-20240112115711

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608907
Report Date: 09/26/2023
Date Signed: 09/26/2023 04:16:57 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
09/22/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230922112528

FACILITY NAME:	COMPASSIONATE ELDERLY CARE MANAGEMENT SYSTEMS, INC		FACILITY NUMBER:	197608907
ADMINISTRATOR:	CELIA T. OYIBU		FACILITY TYPE:	740
ADDRESS:	44161 11TH ST. W		TELEPHONE:	(661) 317-7354
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	6	CENSUS: 4	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Celia Oyibu		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff left resident in wet diaper for an extended period of time
Facility refused to accept resident back from hospital

INVESTIGATION FINDINGS:

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At 10:30 am. on 09/26/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and later the Administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA interviewed three (03) out of three (03) staff and two (02) out of four (04) residents present at the facility today between 11:00 a.m. and 12:30 p.m. and reviewed pertinent records at 1:00 p.m. Records included but were not limited to the staff list, resident list, face sheet, medication schedule, discharge evaluation, insurance verification form, and medical assessment

Regarding the allegation “Staff left resident in wet diaper for an extended period of time” it was alleged that Resident #1 (R1) arrived at the hospital with a soiled diaper. Interview with the Administrator today at 11:00 a.m. revealed an ambulance came to pick up R1 at approximately 10:45 a.m. on 09/20/2023.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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-20230922112528

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: COMPASSIONATE ELDERLY CARE MANAGEMENT SYSTEMS, INC	FACILITY NUMBER: 197608907
	VISIT DATE: 09/26/2023

NARRATIVE

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The Administrator had the paramedics wait while she provided R1 with a clean diaper, and the ambulance left at approximately 11:00 a.m. Staff interviews at 11:45 a.m. and 12:00 p.m. today confirmed R1 was changed at least 3 times per day or as needed, and R1 was never left in a soiled diaper at the facility. Based on interviews, there is insufficient evidence to verify the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Facility refused to accept resident back from hospital” it was alleged the facility did not readmit R1 to the facility after R1 was admitted to the hospital. Interview with the Administrator at 11:00 a.m. today revealed R1 was hospitalized on 09/20/2023 for general weakness and overall change in condition. The Administrator noted the facility was able to provide care and supervision to R1 based on observations and records reviewed during the preplacement appraisal process. R1 could not be readmitted due to their change of condition, which made them no longer suitable for the facility. It was determined R1 needed a higher level of care. Staff interviews at 11:45 a.m. and 12:00 p.m. today confirmed R1 exhibited aggressive behaviors which were not documented in their records and were verbally confirmed after admission. Record review at 1:00 p.m. today of R1’s medical assessment and discharge evaluation revealed R1 had some cognitive impairment and physical challenges, but the documents did not mention the behaviors which were exhibited at the facility. Based on interviews and record review, the facility was not able to accommodate R1’s needs. Therefore, the allegation is deemed UNSUBSTANTIATED at this time, and the insufficient preplacement appraisal is addressed on a separate case management report.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

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