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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609011
Report Date: 06/14/2023
Date Signed: 06/14/2023 03:15:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
06/08/2023 and conducted by Evaluator Evelin Rios
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230608131051
FACILITY NAME:STRAWBERRY COTTAGEFACILITY NUMBER:
197609011
ADMINISTRATOR:TAYLOR, DAVID JAMESFACILITY TYPE:
740
ADDRESS:43732 SENTRY LANETELEPHONE:
(661) 266-7995
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 6DATE:
06/14/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:David James TaylorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility did not arrange, or assist in arranging, for necessary medical care for resident(s).
Facility did not arrange, or assist in arranging, for transportation of resident(s) to and/or from hospital.
INVESTIGATION FINDINGS:
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On 06/14/2023 Licensing Program Analysts (LPAs) Evelin Rios and Melissa Ruiz conducted an unannounced complaint visit for the above allegations. LPAs arrived at the facility at 10:00 a.m. and were greeted by staff#1 (S1) who granted access. S1 called the Administrator David James Taylor and met with LPA shortly after. LPAs informed him about the purpose of the visit.

Allegation #1:Facility did not arrange, or assist in arranging, for necessary medical care for resident(s).
It is alleged resident#1 (R1) has requested assistance with receiving a consistent replenishment of portable oxygen which facility has failed to obtain and furthermore has failed to make arrangements for R1 to see a physician per R1s request. To investigate this allegation LPA interviewed residents and administrator from 11:00 a.m. to 12:00 p.m. Interview with R1 revealed that about three months ago they had requested to see a physician for a health concern and according to R1, the administrator did not assist them with arranging the appointment.
(LIC9099-C Continued on next page)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
06/08/2023 and conducted by Evaluator Evelin Rios
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230608131051

FACILITY NAME:STRAWBERRY COTTAGEFACILITY NUMBER:
197609011
ADMINISTRATOR:TAYLOR, DAVID JAMESFACILITY TYPE:
740
ADDRESS:43732 SENTRY LANETELEPHONE:
(661) 266-7995
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 6DATE:
06/14/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:David James TaylorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Facility does not provide food services of quality and/or quantity necessary to meet the needs of the residents.
INVESTIGATION FINDINGS:
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On 06/14/2023 Licensing Program Analysts (LPAs) Evelin Rios and Melissa Ruiz conducted an unannounced complaint visit for the above allegations. LPAs arrived at the facility at 10:00 a.m. and were greeted by staff#1 (S1) who granted access. S1 called the Administrator David James Taylor and administrator met LPAs shortly after. LPAs informed him about the purpose of the visit.

At approximately 10:20 a.m. LPAs conducted a physical plant tour of the facility. At 10:35 a.m. LPA toured the kitchen and observed the stored items of the refrigerator, the pantry and a kitchen cabinet. LPA also went into the garage and observed the stored items of the deep freezer and the second refrigerator.

Allegation: Facility does not provide food services of quality and/or quantity necessary to meet the needs of the residents.
(LIC9099-C continued on next page)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
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 5
Control Number 31-AS-20230608131051
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: STRAWBERRY COTTAGE
FACILITY NUMBER: 197609011
VISIT DATE: 06/14/2023
NARRATIVE
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It is alleged resident #1 (R1) has to purchase their own food because the facility does not serve good quality meats and there is never any milk, eggs, and/or coffee at the facility. To investigate this allegation LPA toured the kitchen and viewed the stored items in two out of two refrigerator, one deep freezer and reviewed the meal calendar. LPA observed frozen meat from the butcher section and prepaid meats. LPA also observed eggs, milk and eggs in the refrigerator and coffee in the kitchen cabinet. Based on observation this allegation deemed Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20230608131051
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: STRAWBERRY COTTAGE
FACILITY NUMBER: 197609011
VISIT DATE: 06/14/2023
NARRATIVE
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LPAs interview with the administrator revealed the administrator was away on vacation for the month of May and this was confirmed by LPA's previous visit made on 05/03/2023. Administrator confirmed no appointments have made due to issues with R1's insurance. Administrator states they are not aware of any staff arranging appointments for R1. Furthermore in the interview with R1, R1 stated they do not feel comfortable or safe going to appointments without enough portable oxygen. Lastly interview with R1 revealed that they recently missed an appointment due to an appointment at 1:30 p.m. and staff arriving to the facility to pick them up at 1:15 p.m. Administrator also confirmed staff arrived between 1:13 p.m. -1:15 p.m. Based on interviews and record review this allegation is Substantiated.


Allegation #2: Facility did not arrange, or assist in arranging, for transportation of resident(s) to and/or from hospital. It is alleged that on 5/28/2023 R1 was discharged from the hospital and no transportation or arrangement was made to have him return to the facility. To investigate this allegation at approximately 11:00 a.m. LPA Rios conducted interviews with residents and Administrator. At 12:00 p.m. LPA reviewed resident records and obtained documents relevant to this investigation. Records revealed R1 was discharged from the hospital at 1:48 a.m. R1 stated the hospital was trying to contact the facility repeatedly but were unable to reach anyone. R1 had to make arrangements with a friend and did not arrive to the facility until approximately 7:30 a,m, Furthermore Administrator confirmed the hospital had contacted his personal phone number while he was on vacation and designee was out of town. Based on interviews and record review this allegation is Substantiated.

Deficiencies cited (refer to 9099-D).Copy of this report and appeals provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Citations on this Visit Report are Under Appeal!

Control Number 31-AS-20230608131051
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: STRAWBERRY COTTAGE
FACILITY NUMBER: 197609011
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
06/30/2023
Section Cited
CCR
87465(a)(1)
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(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents
This requirement is not met as evidenced by:
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Licensee shall read cited regulation and submit a statement of understanding to LPA by POC due date.
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Based on interviews and record review, the licensee did not ensure that R1 made it to a scheduled appointment on one occasion which posses a potential health, safety, or personal rights risk to residents in care.
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Under Appeal
Type B
06/30/2023
Section Cited
CCR
87464(f)(6)
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87464 Basic Services (f) Basic services shall at a minimum include: (6) Arrangements to meet health needs, including arranging transportation, as specified in Section 87465, Incidental Medical and Dental Care Services. This requirement is not met as evidenced by:
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Licensee shall conduct training for all staff, training shall specifically include arranging transportation for medical appointments, medical emergencies, or outings. Proof of training and any training materials shall be submitted by the POC due date.
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Based on interviews and record review, the licensee did not ensure that timely or adequate transportation was provided for R1 upon discharge from the hospital. This posses a potential health, safety, or personal rights 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.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5