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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609532
Report Date:
01/19/2022
Date Signed:
01/19/2022 01:45:06 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
11/25/2020
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20201125120201
FACILITY NAME:
SUNRISE ASSISTED LIVING OF WEST HILLS
FACILITY NUMBER:
197609532
ADMINISTRATOR:
EDITH KENNEDY
FACILITY TYPE:
740
ADDRESS:
9012 TOPANGA CANYON ROAD
TELEPHONE:
(703) 273-7500
CITY:
WEST HILLS
STATE:
CA
ZIP CODE:
91304
CAPACITY:
90
CENSUS:
55
DATE:
01/19/2022
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Rita Meldonian
TIME COMPLETED:
01:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was inappropriately restrained while in care
Staff not properly reporting an incident regarding a resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent complaint visit to finish investigation into the allegations above. LPA met with the administrator Rita Meldonian and explained there reason for this visit.
It is alleged that resident #1 (R1) was inappropriately restrained while in care on 10/18/2020. LPA conducted a previous visit on 12/3/2020 where interviews were done with the administrator of the facility at that time. During today's visit LPA conducted interviews with staff and former staff from 10am-12pm regarding the allegation. LPA attempted to interview R1 but R1 was not able to recall what happened during the incident. LPA spoke with R1's responsible person regarding the alleged incident. Information from interviews reveal that R1 is blind and cannot see or and was having issues with falls during that time. Staff put R1's pull chord next to their pendant watch so that R1 would know to pull it if they needed assistance in the middle of the night. During the night it appears that the pull chord became tangled with R1's watch and when staff went to check on R1 it appeared R1 was being restrained. There were no injuries noted to R1 during the alleged incident.
Unsubstantiated
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:
01/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/19/2022
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
2
Control Number
31-AS-20201125120201
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
VISIT DATE:
01/19/2022
NARRATIVE
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32
Based on information obtained from interviews it could not be found that R1 was restrained purposely or if R1's chord got tangled with their pendant. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.
Staff not properly reporting an incident regarding a resident
It was alleged that regarding the alleged incident where R1 was restrained that the facility did not report the incident to licensing. LPA had previously interviewed the administrator at the time and the present administrator. Information from interviews revealed that there was no injury to R1 and that they did not view the incident with R1 as any type of abuse or R1 being restrained. They stated due to R1 being blind and was having falls at that time so the pull chord was placed by her in case she needed it. Based on the information obtained through interviews and due to no injuries being noted on R1 this allegation is deemed Unsubstantiated at this time.
Exit Interview conducted.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
01/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/19/2022
LIC9099
(FAS) - (06/04)
Page:
2
of
2