197608998-8-25-2021-31-AS-CHAS-C7QRS2-20211012131602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608998
Report Date: 08/25/2021
Date Signed: 08/25/2021 02:03:58 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
08/24/2021 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20210824130453

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: 80	DATE:	08/25/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Susan Weisbarth		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Resident fell while in care.

Uncleared staff working at facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate this allegations above. LPA met with the administrator and explained the reason for this visit.

Resident fell while in care
It is alleged that resident #1 (R1) had a fall in the facility and that no staff was around to assist R1 on 8/21/21. LPA conducted an interview with the administrator regarding this allegation. LPA also conducted an interview with R1 regarding the allegation. Information revealed that on 8/21/21 at approximately 10:45 am R1 had a fall while in their room. LPA also interviewed a witness who was in the next room who heard the fall. Information obtained through interviews revealed that at 10:45 am while in the room R1 had an unwitnessed fall. A visitor who was visiting another resident heard and went to R1's room and observed them to be on there hands and knees with blood coming from their head. The visitor pushed R1's pendant and immediately ran downstairs to get staff. According to the witness staff came and rendered aid immediately and R1 was then sent out via emergency services.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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-20210824130453

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: 08/25/2021

NARRATIVE

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LPA obtained copies of the incident report, R1's care plan, physician report, and medical documentation from R1's hospital visit. LPA reviewed R1's care plan and physician report from 10am-10:30 am. Based on information obtained through interviews and record review this allegation is deemed Unsubstantiated at this time. R1 had a fall which was unobserved and responded in a timely manner.

Uncleared staff working in the facility
It is alleged that the facility has undocumented workers working in the facility. From approximately 11:15am-12pm, LPA conducted interviews with random staff regarding this allegation. LPA also reviewed random staff files from 12-12:30pm to see if they were fingerprint cleared and associated to the facility. Based on the information obtained through interviews and record review this allegation is deemed Unsubstantiated at this time. Exit Interview conducted.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC9099 (FAS) - (06/04)

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