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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609011
Report Date: 09/13/2023
Date Signed: 09/13/2023 04:23:38 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
09/08/2023 and conducted by Evaluator Evelin Rios
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230908152350
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:
09/13/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Hailam P. TaylorTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Staff did not assist resident in a timely manner.
Staff did not provide a safe and comfortable environment for resident.
INVESTIGATION FINDINGS:
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On 09/14/2023 Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced complaint visit for the above allegations. LPA arrived at the facility at 10:00 a.m. and was greeted by Staff #1 (S1) who granted access. S1 called the Administrator Designee Hailam P. Taylor. Administrator David Taylor was unavailable. Hailam met LPA shortly after. Hailam contacted Administrator David Taylor via telephone and LPA explained to Administrator Designee Hailam and the Administrator David Taylor the purpose of the visit. Hailam will sign todays report. An entrance interview was conducted.

At 10:15 a.m. LPA conducted a physical plant tour to ensure the health and safety of the residents in care. From 10:30 a.m. to 12:00 p.m. LPA conducted interviews with Administrator and Staff #2 (S2) over the phone. LPA conducted interviews with Administrator designee, S1 and three (3) out of six (6) residents at the facility. From 12:00 p.m. to 2:44 p.m. LPA reviewed resident records and obtained documents relevant to this investigation.
(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023
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
Control Number 31-AS-20230908152350
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: 09/13/2023
NARRATIVE
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Allegation #1: Staff did not assist resident in a timely manner.
In regards to the allegation it was reported Resident #1 (R1) had an unwitnessed fall in one of the facility bathrooms and was lying on the bathroom floor without receiving assistance for 30 minutes. To investigate the allegation LPA conducted interviews with three (3) out of six (6) residents and staff #2 (S2), who was present during the incident in question. LPA interview with R1, R1 affirms they had an unwitnessed fall in the bathroom while they were attempting to get out of the bathtub after the fall they eventually were able to get up and inform S2 they had a fall. Interview with S2 corroborates R1 notified them they had a fall in the bathroom. Interview with S2 revealed they did not hear R1 have a fall and didn't realize R1 was taking a shower. Interview with various resident's revealed they have waited over a minute to an hour for assistance after pushing their call button, ringing a bell or calling out for assistance. Staff schedule revealed there is usually one staff present in the AM shift and one staff present in the PM shift for six (6) residents. Staff interview revealed if staff is assisting a resident in the shower they have to complete the shower first to then be able to attend to other residents which can take over 5 to 10 minutes. Based on interviews and record review this allegation is Substantiated at this time.

Allegation #2: Staff did not provide a safe and comfortable environment for resident.
In regards to the allegation it was reported that R1's mattress needs to be replaced and the bathroom R1 one uses needs a grab bar when getting out of the bathtub. To investigate the allegation LPA conducted interviews with R1, staff and conducted a physical plant tour. LPA interview with R1 revealed they believe the fall in bathroom could have been prevented had there been a grab bar on the outside of the bathtub/shower. LPA observed the bathroom in question and although the bathroom is equipped with one grab bar by the toilet and another inside the bathtub/shower, it does not have one at reach for residents entering or exiting the bathtub. Interview with staff revealed most residents shower in the second bathroom that has a walk in shower. LPA observed the second bathroom is located farthest from the residents' bedrooms. LPA's review of R1 records revealed R1 is ambulatory, however is assisted with a device to get around. In regards to R1's mattress, LPA's review of facility records revealed facility had purchase a new mattress in May 2023 - June 2023. Administrator designee stated they have rotated the mattress but may either purchase a bed topper or take R1 to pick out their own mattress. Based on interviews, record review and LPA's observation the allegation "facility needs a grab bar" is Substantiated at this time.

Deficiencies cited on LIC9099-D. Exit interview conducted. Appeals Rights provided. Copy of report provided
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20230908152350
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: 09/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
09/22/2023
Section Cited
CCR
87303(e)(4)
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(e) Water supplies and plumbing fixtures shall be maintained as follows:(4)Grab bars shall be maintained for each toilet; bathtub and shower used by residents. This requirement is not met as evidenced by:
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Administrator agreed to add grab bar. Administrator will submit a picture of grab bar to LPA by POC due date.
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Based on interviews and observation, the licensee did not ensure that R1 had a grab bar that allowed them to safely enter and exit the bathtub which posses a potential health, safety, or personal rights risk to residents in care.
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Request Denied
Type B
09/22/2023
Section Cited
CCR
87468.2(a)(4)
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Additional Personal Rights of Residents in Privately Operated Facilities.
To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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Administrator is to submit to LPA a plan to ensure that Section 87468.2(a)(4) will be complied with at all times.
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This requirement was not met as evidenced by: Various interviews and observation revealed that staff do not responded to the call for assistance from residents in a timely manner. This poses a potential health and safety risk to the 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: 09/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023
LIC9099 (FAS) - (06/04)
Page: 3 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
09/08/2023 and conducted by Evaluator Evelin Rios
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230908152350

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:
09/13/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Hailam P. TaylorTIME COMPLETED:
04:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not meet resident's needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/14/2023 Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced complaint visit for the above allegations. LPA arrived at the facility at 10:00 a.m. and was greeted by Staff #1 (S1) who granted access. S1 called the Administrator Designee Hailam P. Taylor. Hailam met LPA shortly after. Hailam contacted Administrator David Taylor via telephone and LPA explained to Administrator Designee Hailam and the Administrator David Taylor the purpose of the visit. Hailam will sign todays report.

At 10:15 a.m. LPA conducted a physical plant tour to ensure the health and safety of the residents in care. From 10:30 a.m. to 12:00 p.m. LPA conducted interviews with Administrator and Staff #2 (S2) over the phone. LPA conducted interviews with Administrator designee, S1 and four (4) out of six (6) residents at the facility. From 12:00 p.m. to 2:44 p.m. LPA reviewed resident records and obtained documents relevant to this investigation.
(Continued on LIC9099-C)

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20230908152350
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: 09/13/2023
NARRATIVE
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Allegation: Staff did not meet resident's needs.
In regards to the allegation it was reported, R1 was denied food between 12:30 p.m.- 6:00 p.m. LPA interview with R1, R1 affirms they had asked staff #3 (S3) for food and S3 denied to serve them a meal because they did not serve between 12:30 p.m. to 6:00 p.m. Interview with staff revealed they try their best to serve meals R1 will eat and serve meals when it is requested no matter the time. Staff denies the allegation. Resident interviews state they like the food served at the facility and have not been denied food or snacks when they have asked. LPA could not find any witness to corroborate the allegation. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5