197609532-6-18-2021-31-AS-CHAS-CBJUQD-20220211144659

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609532
Report Date: 06/18/2021
Date Signed: 06/18/2021 01:39:00 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/28/2021 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20210428094612

FACILITY NAME:	SUNRISE ASSISTED LIVING OF WEST HILLS		FACILITY NUMBER:	197609532
ADMINISTRATOR:	RITA MELDONIAN		FACILITY TYPE:	740
ADDRESS:	9012 TOPANGA CANYON ROAD		TELEPHONE:	(818) 701-9550
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91304
CAPACITY:	90	CENSUS: 56	DATE:	06/18/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Liza Bond		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Another resident going into residents room due to lack of supervision
Resident's belongings being taken by another resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith conducted a subsequent complaint visit to finish investigation into the allegations above. LPA met with facility staff and explained the reason for this visit.
Regarding the allegations above LPA conducted previous visits on 5/4/21, 5/21/21, and 5/22/21 to conduct interviews and obtain copies of pertinent information.
Regarding both allegations above it is alleged that resident # 1 (R1) room was being entered by another resident who would wander into R1's room and that R1's belongings would be taken by the other resident. LPA conducted interviews with R1's responsible person and facility staff regarding the allegations. Information from interviews revealed that both residents lived in the memory care unit of the facility. Interviews revealed that the other resident would wander into R1's room unannounced and uninvited and would move R1's belongings but that the belongings would later be found somewhere else. Based on the information obtained through interviews both of these allegations are deemed Substantiated. Deficiency cited on LIC 9099 D. Appeal Rights explained. Exit Interview conducted.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021

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-20210428094612

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: SUNRISE ASSISTED LIVING OF WEST HILLS	FACILITY NUMBER: 197609532
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/18/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/21/2021 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	Personal Rights of residents in All facilities: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator will have an in-service with memory care staff on the importance of supervising residents that wander so they don't enter into other residents rooms unannounced. Copy of in-service sign in sheet will be sent to LPA.
	8 9 10 11 12 13 14	Based on information obtained through interviews R1 belongings were touched and their room was repeatedly entered by another resident which posed a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021

LIC9099 (FAS) - (06/04)

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