197609049-12-6-2023-31-AS-NMAN-CZEP2H-20240112095554

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609049
Report Date: 12/06/2023
Date Signed: 12/06/2023 09:38:32 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
02/07/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230207083538

FACILITY NAME:	FALLBROOK GLEN OF WEST HILLS		FACILITY NUMBER:	197609049
ADMINISTRATOR:	LILIT CHAPARYAN		FACILITY TYPE:	740
ADDRESS:	6833 FALLBROOK AVE		TELEPHONE:	(818) 883-4123
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	114	CENSUS: 41	DATE:	12/06/2023
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Stephanie Oden		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Staff did not ensure that resident had access to medical devise resulting in a fall.
Staff do not assist resident with grooming.
Staff are not providing adequate care and supervision to resident.

INVESTIGATION FINDINGS:

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At 8:20 a.m. on 12/06/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent complaint visit. LPA met with the Administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted record reviews at 11:00 a.m. on 02/08/2023 and at 12:00 p.m. on 09/13/2023 of records including but not limited to a resident face sheet, identification form, driver’s license, physician’s report, narrative charting, and fall risk assessment, interviewed 10% of residents [six (06) out of fifty-four (54) residents] at 12:30 p.m. on 09/13/2023, between 1:30 p.m. and 2:30 p.m. on 09/20/2023, and between 12:00 p.m. and 1:30 p.m. on 10/09/2023, interviewed staff at 10:20 a.m. on 02/08/2023 and between 10:00 a.m. and 1:00 p.m. on 09/13/2023. LPA toured the facility today at 8:45 a.m.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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 3

Control Number 31-AS-20230207083538

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: FALLBROOK GLEN OF WEST HILLS	FACILITY NUMBER: 197609049
	VISIT DATE: 12/06/2023

NARRATIVE

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Regarding the allegation “Staff did not ensure that resident had access to medical devise resulting in a fall” it was alleged Resident #1 (R1) fell in their room due to not having their walker nearby. Record review at 11:00 a.m. on 02/08/2023 revealed the fall risk assessment for R1 was at a level 3 out of 3 risk for falls on the Morse Fall Scale and the facility should “implement high risk fall prevention interventions”. R1’s preplacement appraisal noted R1 used both a walker and wheelchair. LPA interviewed R1 at 12:30 p.m. on 09/13/2023. Although R1 did not communicate any relevant information, LPA observed R1’s walker and wheelchair within arm’s reach of their bed. Interview with former Administrator Elizabeth Whittington at 10:20 a.m. on 02/08/2023 revealed R1 was witnessed walking through the hallways without any issues. The Administrator had not recalled any fall incidents with R1 and believed R1’s walker was with them at all times. Interview with Staff #1 (S1) at 12:45 p.m. on 09/13/2023 and Staff #2 (S2) at 11:15 a.m. on 10/09/2023 revealed staff were aware of R1’s risk for falling and ensured R1 had their walker. Interview with Visitor #1 (V1) at 1:00 p.m. on 10/09/2023 revealed R1 used to push their walker far way from the bed because R1 didn’t think they needed it. V1 wrote a letter to the previous Administrator on 03/15/2023 which stated “R1 is the one who moves their walker”. Based on interviews and record review, R1 was a fall risk, but the facility sufficiently intervened to prevent R1’s falls. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff do not assist resident with grooming” it was alleged R1’s toenails needed to be cut. Interview with Visitor #2 (V2) at 3:00 p.m. on 02/28/2023 revealed that R1’s nails were “approximately ¾ inches longer than their finger”. Record review at 11:00 a.m. on 02/08/2023 indicated from Attachment A to R1’s admission agreement that nail clipping was an ancillary service provided by a podiatrist for an additional cost. Interview with the previous Administrator at 10:20 a.m. on 02/08/2023 revealed facility staff were not trained to cut nails, only to observe a report when nails needed trimming. A podiatrist from outside of the facility would provide nail cutting service. Interview with V1 at 1:00 p.m. on 10/09/2023 and Visitor #3 (V3) at 4:30 p.m. on 10/03/2023 revealed that V3 and R1’s hospice agency visited at least on a weekly basis and cut R1’s nails. V3 and V1 reported they saw no issues with R1’s nails. Based on interviews and record review, the facility appropriately assisted R1 with grooming. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff are not providing adequate care and supervision to resident” it was alleged R1 required increased staff supervision due to episodes of confusion. Record review of staff narrative charting at 11:00 a.m. on 02/08/2023 revealed an instance of R1 defecating in a room on 10/20/2022.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20230207083538

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: FALLBROOK GLEN OF WEST HILLS	FACILITY NUMBER: 197609049
	VISIT DATE: 12/06/2023

NARRATIVE

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A subsequent record review conducted at 12:00 p.m. on 09/13/2023 of an updated physician’s report on 04/04/2023 identified R1 experienced confusion and mild cognitive impairment. A letter sent from V1 on 03/15/2023 described the facility's care of R1 as "exceptional" and stated R1 felt their needs were being met. Interviews with the previous Administrator Elizabeth Whittington at 10:20 a.m. on 02/08/2023, S1 at 12:45 p.m. on 09/13/2023, V1 at 1:00 p.m. on 10/09/2023, and V2 at 3:00 p.m. on 02/28/2023 revealed that the facility and visitors were aware of occasions in which R1 became confused and defecated in inappropriate locations. Administrator Elizabeth addressed the issue with R1 and their family about obtaining a higher level of care. Based on record review and interview, the facility was aware of R1’s increased care needs and relocated R1 to the memory care unit for increased supervision and care. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health or safety hazards were noted during the time of this visit.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

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