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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608998
Report Date: 04/30/2021
Date Signed: 04/30/2021 02:14:30 PM



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
04/26/2021 and conducted by Evaluator Wendell Smith
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210426092913
FACILITY NAME:CANYON TRAILS AT TOPANGA SENIOR LIVINGFACILITY NUMBER:
197608998
ADMINISTRATOR:SUSAN WEISBARTHFACILITY TYPE:
740
ADDRESS:7945 TOPANGA CANYON BLVDTELEPHONE:
(818) 716-9900
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY:120CENSUS: 71DATE:
04/30/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sandra Perez & Liliana SolorzanoTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Resident's room is malodorous

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wendell Smith made an unannounced complaint visit to investigate the allegation above. LPA met with facility staff and explained the reason for this visit.

It is alleged that resident #1 (R1) room had a smell of urine and that there were pest in the drawers of R1's room. LPA conducted a walk through of R1's room. LPA was informed that R1 had moved earlier in the day. LPA did not observe R1's room to smell of urine or of the carpet to have any smell of urine. Interviews with staff revealed that there were pest in the drawers that were brought to their attention awhile ago and that they had the pest control company come and spray the room. LPA received the pest control company report showing that R1's room was sprayed for pest. Based on the information obtained through interviews this allegation is deemed Substantiated due to the room having pest before. Facility has already corrected the issue by having the pest control company come and address the issue when the facility was notified about it.
Deficiency cited on LIC 9099 D. Appeal Rights explained. Copy of report emailed.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell SmithTELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2021
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 3
Control Number 31-AS-20210426092913
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2021
Section Cited
CCR
87303(a)
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Maintenace and Operation-The facility shall be clean, safe, sanitary and in good repair at all times.
This requirement was not met as evidenced by:
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Corrected before visit. Facility has pest control company come to spray rooms where there were pest noted. LPA received copy of pest control report.
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Based on interviews conducted R1's room was observed to have pest which could have posed a health and safety risk to residents in care.
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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: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell SmithTELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3
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
04/26/2021 and conducted by Evaluator Wendell Smith
COMPLAINT CONTROL NUMBER: 31-AS-20210426092913

FACILITY NAME:CANYON TRAILS AT TOPANGA SENIOR LIVINGFACILITY NUMBER:
197608998
ADMINISTRATOR:SUSAN WEISBARTHFACILITY TYPE:
740
ADDRESS:7945 TOPANGA CANYON BLVDTELEPHONE:
(818) 716-9900
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY:120CENSUS: 71DATE:
04/30/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sandra Perez & Liliana SolorzanoTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff are not using fall prevention device
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wendell Smith made an unannounced complaint visit to investigate the allegation above. LPA met with facility staff and explained the reason for this visit.

It is alleged that staff are not allowing resident #1 (R1) to use their fall prevention device due to the fact it was observed that the mat was observed under R1's bed and not at the side. LPA conducted an interview with staff regarding this allegation. LPA conducted a walk through of R1's room which has since been vacated. Interviews revealed that during the day when R1 was not in bed the mat would be placed under the bed and was only placed on the side of the bed when R1 was in bed. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.
Exit Interview conducted. Copy of report emailed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell SmithTELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3