197609518-2-15-2022-29-AS-JAPL-CBPNQF-20220216093953

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609518
Report Date: 02/15/2022
Date Signed: 02/15/2022 03:29:46 PM

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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/09/2021 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20211109162243

FACILITY NAME:	BELMONT VILLAGE CALABASAS		FACILITY NUMBER:	197609518
ADMINISTRATOR:	NELSON, NANCY		FACILITY TYPE:	740
ADDRESS:	24141 VENTURA BLVD		TELEPHONE:	(818) 222-2600
CITY:	CALABASAS	STATE: CA	ZIP CODE:	91302
CAPACITY:	165	CENSUS: 127	DATE:	02/15/2022
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Nancy Nelson		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Memory care residents are being video-recorded with the Safely-U Monitoring system without their consent.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced for subsequent complaint visit. The LPA met with Executive Director Nancy Nelson and explained the reason for the visit.

During the initial visit conducted on 11/16/2021, the LPA conducted a physical plant tour at 12:26 p.m., reviewed documents, and interviewed staff at 1:16 p.m., 1:59 p.m. and 2:15 p.m.

Regarding the above allegation, it was alleged that memory care residents were being recorded without their consent. Interviews and records review revealed that this facility utilizes the SafelyYou system, which is a fall detection program that detects when a fall takes place in a resident’s room. Research and staff interviews revealed that the video surveillance is not monitored by staff but is monitored by artificial intelligence. When the SafelyYou’s artificial intelligence detects a body on the ground, the program sends a ‘fall’ video to the SafelyYou system, which is only accessible by management and the nurse on duty. The clip captures the fall approximately ten minutes prior to the event, and approximately ten minutes following the perceived fall.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022

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 29-AS-20211109162243

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BELMONT VILLAGE CALABASAS	FACILITY NUMBER: 197609518
	VISIT DATE: 02/15/2022

NARRATIVE

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The staff do not have access to any other video clips other than what is provided by the software. As many residents in the memory care unit have cognitive impairment, oftentimes they are unable to communicate how or what caused a fall. The clip allows staff to assess the action that precedes the fall, the severity of the fall (ie. if a resident hit their head) and can determine whether there are other fall prevention measures needed in the room. Furthermore, it allows the staff to assess if an actual fall occurred; for example, a resident could be picking up something from the floor. Staff stated that the usage of the system has drastically reduced the usage of emergency personnel. Lastly, there isn’t any live video streaming, no audio recording, and the non-fall video surveillance is deleted from the system. Simultaneously, facility staff are alerted that a fall has taken place in a resident’s room, and staff are able to respond to a perceived fall in a timely fashion.

Prior to the implementation of the SafelyYou system, the facility held conference calls and video conferences with families, explaining the use of the system. All informed parties were given the option to opt in or opt out of the SafelyYou system. The physical plant tour revealed that the SafelyYou cameras are installed in all memory care rooms; however, if consent is not provided, the camera is not activated in the resident’s room. However, it was reiterated that consent can be rescinded at any time.

After further review, the Department applies the following definition of “informed consent”, which is: “A person’s agreement (or that of their legally authorized representative’ to allow something to happen, made with full knowledge of the risks involved and the alternatives,” (Source: Garner, Bryan, editor. Black’s Law Dictionary, 4th Pocket Ed. West Group Publishing, St. Paul, Minn, 2011, p. 149). Per the interviews and record review, the facility does their due diligence to ensure that consent was received from the resident’s responsible party. Although facility residents may be informed of the SafelyYou system, due to their cognitive impairment, the resident may not retain this knowledge at a later time or date. Should a resident display concern regarding the system, further discussion would be had with the resident's responsible party. The facility provided the signed copies of the consent forms, verifying that the resident’s responsible party agreed to the usage of the SafelyYou monitoring system in the resident's room.

Based on the investigation, there is insufficient evidence to support the claim that memory care residents are being video-recorded with the Safely-U Monitoring system without their consent. The consent is provided by the resident’s legally authorized representative. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022

LIC9099 (FAS) - (06/04)

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