197609496-10-2-2024-31-AS-NMAN-DA6V37-20241018160415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609496
Report Date: 10/02/2024
Date Signed: 10/02/2024 03:22:47 PM

Unsubstantiated

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
10/31/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20231031161113

FACILITY NAME:	ENCINO TERRACE SENIOR LIVING		FACILITY NUMBER:	197609496
ADMINISTRATOR:	ARTEAGA, IRMA		FACILITY TYPE:	740
ADDRESS:	16025 VENTURA BLVD		TELEPHONE:	(818) 986-8466
CITY:	ENCINO	STATE: CA	ZIP CODE:	91436
CAPACITY:	85	CENSUS: 34	DATE:	10/02/2024
		UNANNOUNCED	TIME BEGAN:	11:54 AM
MET WITH:	Katia Arriaga		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff did not seek timely medical attention for a resident

INVESTIGATION FINDINGS:

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On 10/02/2024, Licensing Program Analyst (LPA) Abeye Duguma visited the facility to deliver findings.

On Licensing Program Analyst (LPA) Tihesha Smith made an unannounced subsequent complaint visit to this facility at approximately 11:25 am. LPA Smith met the administrator and disclosed the purpose of the visit.

Staff did not seek timely medical attention for a resident

On 11/07/2023, during the initial complaint visit, LPA Tihesha Smith conducted interview with the Business Director and staff. From approximately 12:10 pm to 2:50 pm, LPA Smith toured Resident #1(R1) room, requested and reviewed copies of documents relevant to the investigation.

(CONT. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024

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-20231031161113

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: ENCINO TERRACE SENIOR LIVING	FACILITY NUMBER: 197609496
	VISIT DATE: 10/02/2024

NARRATIVE

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These documents included, but were not limited to, R1 admissions agreement, transport document and hospital admission and discharge documents. LPA Smith was unable to interview R1 as they were not present at the facility during time of visit.

Interviews with three (3) of three (3) staff revealed that R1 refused to be taken to the hospital when 911 was contact on 10/30/2023 Two (2) of three (3) staff revealed when residents refuse medical service and or transport, the paramedic staff are not happy and express their disapproval. The next day on 10/31/2023, R1 began to experience pain from leg injury and wanted to be taken to hospital. Facility staff called for transport and R1 was taken to the hospital on 10/31/2023.

During interviews with residents, six(6) out of six (6) residents stated they feel staff seek medical attention timely.

LPA Smith reviewed R1 records which included daily notes, transport documents, medical documents, and incident reports. Records reveal 911 was contacted for R1 and R1 was taken to the hospital by ambulance in a timely manner.

Based on interviews and record review there is not enough sufficient evidence to support the allegation. Therefore, the allegation is Unsubstantiated at this time.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024

LIC9099 (FAS) - (06/04)

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