197608998-3-11-2023-31-AS-RRAZ-CQBK4P-20230327073439

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608998
Report Date: 03/11/2023
Date Signed: 03/11/2023 01:11:59 PM

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
10/12/2022 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20221012091416

FACILITY NAME:	CANYON TRAILS AT TOPANGA SENIOR LIVING		FACILITY NUMBER:	197608998
ADMINISTRATOR:	SUSAN WEISBARTH		FACILITY TYPE:	740
ADDRESS:	7945 TOPANGA CANYON BLVD		TELEPHONE:	(818) 716-9900
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91304
CAPACITY:	120	CENSUS: 84	DATE:	03/11/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Diane Parras - Staff		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident sustained unexplained fracture while in care

Staff are not meeting resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to deliver the findings for the above allegations. LPA met with staff Diane Parras who called the administrator and explained the reason for the visit. The administrator designated Ms. Parras to sign the report.

On 10/12/22, a complaint was received by the Woodland Hills Adult and Senior Care Regional Office. The complaint was referred to and accepted by Community Care Licensing Division’s Investigations Branch (IB) and assigned to IB investigator Dennis Seng.

On 10/13/22 at 8:40 AM, LPA initiated the complaint visit. LPA interviewed staff and obtained copies of the facility records relevant to the investigation. During the course of the investigation, Investigator Seng interviewed the administrator, staff family member and resident of the facility on different dates and time from 10/19/22 to 01/06/23. IB Investigator Seng also reviewed hospital records on 01/09/23. (continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2023

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-20221012091416

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: CANYON TRAILS AT TOPANGA SENIOR LIVING	FACILITY NUMBER: 197608998
	VISIT DATE: 03/11/2023

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that Resident sustained unexplained injury while in care, it was alleged that Resident #1 (R1) broke a leg six (6) months ago due to a fall and again had an unwitnessed fall on 10/10/22 wherein R1 broke own left leg again. R1 was hospitalized both times. IB Investigator Seng’s record review on 01/09/23 revealed that R1 had a fall at the facility on 05/06/22 and was transported to West Hills Hospital for a fractured left femur. R1 had a surgery and was discharged to a Rehabilitation Center on 05/09/22. R1 came back to the facility on 05/26/2022. On 05/30/2022 R1 was transported to West Hills Hospital for right shoulder pain sustained from an unwitnessed fall at the facility. R1 was released on 06/01/2022 back to the facility.

On 10/10/2022 R1 was transported to West Hills Hospital for a left leg fracture sustained from another unwitnessed fall at the facility. From the time of admission of R1 on 11/01/20 up to the assessment dated 02/27/22, R1 was assessed not to be a fall risk and required no assistance with transfer, transport/escort.
Investigator Seng’s interview with staff on 01/05/23 revealed that during R1’s initial fall on 05/06/22, staff was present attending to R1 when R1 fell. Moreover, the facility conducted fall assessment on R1 on 05/06/22, 05/30/22 and 05/31/22 or immediately after each fall except for the 10/10/22 fall wherein R1 did not return to the facility from the hospital. The facility implemented new fall protocol after each fall assessment for R1.
Investigator Seng’s further record review also revealed that all three (3) fall incident of R1 was reported to CCL in a timely manner and R1 was brought to the hospital immediately after each fall.

Regarding the allegation that staff are not meeting resident's needs, it was alleged that staff wouldn’t let R1 get up and move around to strengthen R1's leg, LPA's record review today between 9:30 AM to 10:20 AM revealed that R1 was able to ambulate and transfer on R1's own. Further, on 08/17/22, R1 was evaluated by the in house Physical Therapy company to use cane and had been undergoing physical therapy from then on. LPA's interview with staff today between 10:30 AM to 12:00 PM revealed that no staff denied R1 to get up nor to move around as R1 was able to get up, transfer and ambulate on R1's own during stay at the facility.

Based on the information gathered during the course of the investigation, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2023

LIC9099 (FAS) - (06/04)

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