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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609055
Report Date: 06/10/2024
Date Signed: 06/10/2024 04:17:19 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
06/03/2024 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20240603095102
FACILITY NAME:SK MARATHON HOME CAREFACILITY NUMBER:
197609055
ADMINISTRATOR:KIM, SUN ILFACILITY TYPE:
740
ADDRESS:7246 FALLBROOK AVETELEPHONE:
(818) 912-6757
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 2DATE:
06/10/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sarah KimTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not prevent the residents from having access to cleaning supplies.
Staff did not provide solid waste bins with tight fitting lids.
INVESTIGATION FINDINGS:
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On 06/10/24 at 10:45 am Licensing Program Analyst (LPA), Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegation. LPA met with Administrator Sarah Kim and explained the reason for the visit.

At 11:00 AM LPA Casillas conducted a physical plant tour. During the investigation, interviews and record reviews were conducted. LPA requested copies of resident roster, LIC 500, Liability Insurance and Administrator Certificate. LPA requested copies of pertinent information relevant to the investigation and any information pertaining to residents and care.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena CasillasTELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
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-20240603095102
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SK MARATHON HOME CARE
FACILITY NUMBER: 197609055
VISIT DATE: 06/10/2024
NARRATIVE
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Allegation: Staff did not prevent the residents from having access to cleaning supplies.

It is alleged that staff did not prevent the residents from having access to cleaning supplies. On a visit by Ombudsman on 5/14/2024 Ombudsman observed that a dog collar was being used to secure the cleaning supply cabinet. During the facility tour LPA was not able to observe said collar, LPA did observe that an appropriate lock was securing the cleaning supplies. However, Ombudsman was able to provide a picture of this collar. LPA interviewed the Administrator, and it was revealed that this collar was in fact in place of an actual lock but that a new locking device has been implemented. Based on observations and interviews this allegation is deemed Substantiated at this time.

Allegation: Staff did not provide solid waste bins with tight fitting lids.

It is alleged that staff did not provide solid waste bins with tight fitting lids. On a visit by Ombudsman on 5/14/2024 Ombudsman observed that trash bins throughout the facility did not have tight fitting lids on them. Ombudsman was able to provide a picture of trash cans without lids. LPA interviewed Administrator and it was discovered that Administrator was not aware of this regulation. During facility tour LPA observed that trash cans do have lids, however Administrator admitted to not having trash cans with lids prior to LPA's visit. Based on interview and observation this allegation is deemed Substantiated at this time.

Citations issued. Appeals rights discussed and provided. Exit Interview conducted. A copy of this report provided to Administrator.

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena CasillasTELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
06/03/2024 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20240603095102

FACILITY NAME:SK MARATHON HOME CAREFACILITY NUMBER:
197609055
ADMINISTRATOR:KIM, SUN ILFACILITY TYPE:
740
ADDRESS:7246 FALLBROOK AVETELEPHONE:
(818) 912-6757
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 2DATE:
06/10/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sarah KimTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide adequate food service to the residents
Staff did not properly maintain the resident’s bathroom.
Staff did not provide non-skid mats for the residents.
INVESTIGATION FINDINGS:
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2
3
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5
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13
On 06/10/24 at 10:45 am Licensing Program Analyst (LPA), Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegation. LPA met with Administrator Sarah Kim and explained the reason for the visit.

At 11:00 AM LPA Casillas conducted a physical plant tour. During the investigation, interviews and record reviews were conducted. LPA requested copies of resident roster, LIC 500, Liability Insurance and Administrator Certificate. LPA requested copies of pertinent information relevant to the investigation and any information pertaining to residents and care.

Continued on LIC9099A-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena CasillasTELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20240603095102
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SK MARATHON HOME CARE
FACILITY NUMBER: 197609055
VISIT DATE: 06/10/2024
NARRATIVE
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Allegation: Staff did not provide adequate food service to the residents.

It is alleged that staff did not provide adequate food services to residents. On a visit conducted by Ombudsman on 5/14/2024 Ombudsman observed that food appeared to have mold on it and it was not labeled. During the investigation LPA was provided pictures by the Ombudsman. LPA interviewed Administrator and LPA was advised that the food is a Korean dish containing pickled garlic called “Maneul Jangajji” and that the white substance observed is actually bits of garlic floating. During interviews it was discovered that residents do not eat that particular dish as it is not offered to them. Furthermore, it was revealed that the container that was observed by Ombudsman is for personal staff use, and it is not fed to residents. Based on interviews and observations, this allegation is deemed Unsubstantiated at this time.

Allegation: Staff did not properly maintain the resident’s bathroom.

It is alleged that staff did not properly maintain the resident’s bathroom. On a visit by Ombudsman on 5/14/2024 Ombudsman observed that the resident bathrooms were not kept clean. Ombudsman was able to provide pictures. During facility tour LPA observed that restrooms were clean, however during interview with the Administrator, it was revealed that Ombudsman had arrived before cleaning had been completed. It was discovered that the substance that was observed was a cookie that a resident had spit up as this is part of their behavior and staff had not had the opportunity to clean it up yet. During interview with Administrator it was revealed that facility is cleaned early in the morning and late at night, or when there is something that is visibly soiled, it is immediately cleaned up. Based on interview and observations this allegation is deemed Unsubstantiated at this time.

Allegation: Staff did not provide non-skid mats for the residents.

It is alleged that Staff did not provide non-skid mats for the residents. On a visit by Ombudsman on 5/14/2024 Ombudsman observed that there was a resident restroom that did not have non-skid mats or strips in all bathtubs and showers. Ombudsman was able to provide pictures. During LPA facility tour it was observed that all bathtubs and showers have non-skid mats. LPA interviewed Administrator and it was revealed that the mats are removed for cleaning when not in use. Furthermore, Administrator states that she showed the Ombudsman the mats as they were in the restroom airing out. Based on observation and interview this allegation is deemed Unsubstantiated.

Copy of this report provided to Administrator. Exit interview conducted.

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena CasillasTELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20240603095102
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SK MARATHON HOME CARE
FACILITY NUMBER: 197609055
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2024
Section Cited
CCR
87705(f)(2)
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87705 Care of Persons with Dementia (f) the following shall be stored inaccessible to residents with dementia (2) Over-the-counter medication… and toxic substances such as … cleaning supplies and disinfectants. This requirement is not met as evidenced by:
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The Administrator will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to 87705 Care of Persons with Dementia; The written letter will be sent to the LPA via email by the POC due date.
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Based on an interview and observation, the Administrator did not comply with the section cited above being that Administrator admitted that cleaning supplies were accessible to residents in care. This poses an health and safety risk or personal rights risk to residents in care.
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Type B
06/17/2024
Section Cited
CCR
87303(f)(3)
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87303 Maintenance and Operation (f) Solid waste shall be stored and disposed of as follows (3) All containers, except movable bins, used for storage of solid wastes shall have tight-fitting covers on the containers…This requirement is not met as evidence by:
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Administrator purchased trash bins with lids prior to LPA visit. This POC is cleared.
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Based on interview and observation Administrator failed to have containers with tight fitting lids. This poses a potential health and safety risk 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.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena CasillasTELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5