197608998-9-12-2024-31-AS-RORN-D99KYQ-20240919081927

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608998
Report Date: 09/12/2024
Date Signed: 09/12/2024 04:47:52 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.RO, 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
07/08/2024 and conducted by Evaluator Perchui Khurshudyan

COMPLAINT CONTROL NUMBER: 31-AS-20240708170641

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: 92	DATE:	09/12/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ivan Saa-Executive Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident sustained an unexplained injury while in care of the facility

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 9/12/2024 at 10:00am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted a subsequent complaint visit to the facility to issue the findings regarding the above allegation. Upon arrival LPA Khurshudyan met with Assisted Living Director (ALD) Liliana Solorzano and Executive Direcotor (ED) Ivan Saa and explained the reason for the visit.

Allegation: Resident sustained unexplained injuries while in care of the facility.
It was alleged that on 06/22/24 resident #1 (R1) was observed with the bruise on his arm.
To investigate the allegation initial ten-day visit was conducted on 7/18/2024 by LPA Khurshudyan. At the time of visit LPA obtained a copy of the staff and resident roster and requested residents’ files at 10:15am. At 10:30am, LPA conducted a physical plant tour including the Generation Unit to ensure health and safety of the residents are protected. In addition, between 10:50am and 2:30pm LPA reviewed files and interviewed eight (8) out of eighty-eight (88) residents;
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Perchui Khurshudyan	TELEPHONE: (818) 439-7073
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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 2

Control Number 31-AS-20240708170641

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CANYON TRAILS AT TOPANGA SENIOR LIVING	FACILITY NUMBER: 197608998
	VISIT DATE: 09/12/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

four (4) from the Assisted Living, four (4) from Memory Care Unit and total of 8 staff members including Assisted Living Director, previous Generation Program Director and six (6) caregivers/Med-Techs.

On todays visit, at 10:15am LPA Khurshudyan collected staff and resident rosters, toured the physical plant at 10:45am and interviewed additional four (4) staff and eight (8) out of ninety-two (92) residents between 11:00am to 1:00pm. Staff revealed that they did not witness any incident that could cause bruise on R1’s arm. No staff was able to explain how R1 was bruised. Interview with residents reveal that they are happy with the care provided to them by the staff, caregivers are very gentle, and no one had any concerns regarding possible physical or verbal abuse. The facility submitted Incident report to the Licensing Department informing that on 06/22/24, R1 had a skin tear which was noted by R1’s daughter. When asked, R1 was unable to recall the incident.

Record revealed that R1 had Doctor appointment on 6/25/2024 and was evaluated by the Primary Physician at the Brandman center. Additional information gathered from Physician notes and Medication List revealed that R1 takes GNP Aspirin for blood circulation.

Based on interviews and documentation review, there is insufficient evidence to verify when and how the injuries to R1’s arm occurred. There is no corroborating information/evidence to concur that R1 was bruised due to staff neglect. Therefore, the allegation above noted allegation is deemed UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Perchui Khurshudyan	TELEPHONE: (818) 439-7073
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2