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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608954
Report Date: 02/14/2022
Date Signed: 02/14/2022 02:47:23 PM

Substantiated


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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/12/2021 and conducted by Evaluator Ashley Smith
COMPLAINT CONTROL NUMBER: 29-AS-20210712165319
FACILITY NAME:LIEBELOVE CARE INCFACILITY NUMBER:
197608954
ADMINISTRATOR:GALINA MELKONYANFACILITY TYPE:
740
ADDRESS:6500 QUARTZ AVENUETELEPHONE:
(747) 888-9984
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 4DATE:
02/14/2022
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Ida FahimiTIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Facility failed to properly evaluate R1 prior to admission, resulting in the facility retaining a resident with a prohibited health condition
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to issue findings for the above allegation. Administrator Galina Melkonyan was not available at the time of the visit; however, the LPA met with Ida Fahimi and explained the reason for the visit.

On 07/12/2021, the Department received a complaint alleging that due to staff neglect, Resident #1 (R1) developed an unstageable pressure injury. The complaint was referred to the Community Care Licensing Investigation's Branch (IB) and it assigned to Investigator Robert Kujawa. On 07/13/2021, the LPA toured the facility at 9:10 a.m., conducted a file review at 9:15 a.m., interviewed the Administrator at 9:36 a.m., and collected documents. Investigator Kujawa interviewed facility staff on 9/14/2021 at 3:25 p.m., and on 12/16/2021 at 11:25 a.m., 11:45 a.m., 12:15 p.m.; interviewed a resident on 12/16/2021 at 12:25 p.m.; attempted to interviewed R1’s family members on 10/12/2021; interviewed hospital staff on 1/18/2022 at 3:02 p.m.; interviewed a home health representative on 12/20/2021 at 11:37 a.m.; and, reviewed home health and hospital records on 12/22/2021, 1/5/2022, and 1/21/2022.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022
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 4
Control Number 29-AS-20210712165319
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LIEBELOVE CARE INC
FACILITY NUMBER: 197608954
VISIT DATE: 02/14/2022
NARRATIVE
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Interviews and records review revealed that R1 was admitted to this facility on 7/6/2021 and was discharged on 7/10/2021. Prior to being at this facility, R1 was in a skilled nursing facility from 6/25/2021 through 7/6/2021 due to a fracture. The Physician’s Report, dated 7/5/2021, noted that R1 had discoloration on the left and right heel. The review of the skilled nursing discharge paperwork did not note any wounds; however, there were instructions regarding wound care for both heels. R1 was not receiving hospice care services.

Interviews with the Administrator revealed that the Administrator was aware of R1’s pressure injuries upon admission to the facility but was unaware of the exact staging. The Administrator claimed that R1 was receiving home health services yet stated that they did not communicate with home health regarding the status of R1’s condition, nor did staff receive training regarding proper wound care. The Administrator admitted that R1 was ’heavy’ and that staff had difficulty repositioning R1 as frequently as needed. The Administrator claimed that R1 was moved ‘more than twice a day’. Staff interviews revealed that at least one staff whom cared for R1 during R1’s stay was unaware of any pressure injuries but claimed R1 was repositioned when R1 was being cleaned. Staff whom did not provide care for R1 denied receiving training on proper wound care but claimed knowing that residents should be repositioned every two hours.

A review of facility charting notes revealed that upon admission on 7/6/2021, it was noted that R1 had discoloration on both heels, yet it was written as follows; ‘No instruction yet from doctor/nurse for heel treatment’. Notes revealed that on 7/8/2021, a home health nurse came to evaluate R1, and that R1’s heels were treated with iodine and covered in gauze. However, an interview with a home health representative and a review of home health notes revealed that R1 was only evaluated on 7/8/2021 yet never received care. Charting notes revealed that staff applied iodine on both heels and changed the dressing, noting that R1 was in pain. However, on 7/10/2021, R1 became unresponsive and 9-1-1 was called. A review of medical records revealed that on 7/1/2021, R1 was bought into an emergency department due to increased confusion. Yet upon admission to the hospital, it was documented that R1 had unstageable bilateral heel pressure injuries.

Based on the information obtained, staff did not conduct a proper assessment prior to admitting R1 to this facility, resulting in this facility retaining a resident with a prohibited health condition. In addition, staff admitted to not having instruction for proper wound treatment for R1. R1 was admitted to the hospital on 7/10/2021, and the injuries to both the left and right heel were unstageable bilateral pressure injuries.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20210712165319
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LIEBELOVE CARE INC
FACILITY NUMBER: 197608954
VISIT DATE: 02/14/2022
NARRATIVE
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There is sufficient evidence to support the claim that the staff did not conduct a proper assessment prior to admitting R1 to this facility, thus retaining R1 with a prohibited health condition. This allegation is deemed Substantiated at this time.

The LPA reviewed the findings with Ms. Fahimi. Ms. Fahimi communicated that they were not comfortable signing the report due to the contents of the report, and felt it was best for Administrator Galina Melkonyan to sign. Ms. Fahimi allegedly spoke with Administrator Melkonyan over the phone, whom disagreed with the findings and instructed Ms. Fahimi to not sign the report. Ms. Fahimi communicated to the LPA that had Ms. Melkonyan been available to receive the report, that Ms. Melkonyan would also refuse to sign the report. The LPA explained that signing the report indicates that the report was received by the Facility Representative, not that the Facility Representative agreed with the contents of the report. The LPA stated that the facility could still exercise their appeal rights. Ms. Fahimi communicated understanding, yet claimed that they did not want to sign the report.

A Civil Penalty in the amount of $500 was assessed during today's visit, due to admitting and retaining a resident with a prohibited health condition. The prohibited health condition was not cared for by an appropriately skilled professional while at this facility.

The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. Facility Representatives refused to sign the report. A copy of the report and appeal rights were provided to Ms. Melkonyan via email.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20210712165319
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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LIEBELOVE CARE INC
FACILITY NUMBER: 197608954
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
02/16/2022
Section Cited
CCR
87615(a)(1)
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87615(a)(1) Prohibited Health Conditions. (a) Persons who require health services for or have a health condition including... those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by:
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The Administrator agreed to do the following:
1. Schedule a training regarding Prohibited Health Conditions and Pressure Injuries. Verification of scheduled training with the trainers credentials will need to be submitted by 2/16/2022 and completion of training must be submitted no later than 3/2/2022.
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Based on the investigation, the licensee did not comply with the section cited above, as R1 was retained at this facility with unstageable pressure injuries, which poses an immediate health and safety risk to residents in care.
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Request Denied
Type A
02/16/2022
Section Cited
CCR
87457(c)
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87457(c) Pre-Admission Appraisal – General (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs...
This requirement is not met as evidenced by:
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The Administrator agreed to do the following:
1. Review Regulation 87457. Once reviewed, submit a Plan of Action, indicating how the facility will maintain compliance with the regulation. Submit Plan of Action no later than 2/16/2022, end of day.
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Based on the investigation, the licensee did not comply with the section cited above, as a pre-admission appraisal was not conducted prior to accepting R1, as R1 was accepted with a prohibited health condition, which poses an immediate health and safety risk to residents in care.
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A civil penalty in the amount of $500 has been issued due to admitting and retaining a resident with a prohibited health condition. The prohibited health condition was not cared for by an appropriately skilled professional while at this facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4