197609532-5-22-2021-31-AS-CHAS-CBJUQF-20220211144700

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609532
Report Date: 05/21/2021
Date Signed: 05/22/2021 10:02:02 AM

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:	05/21/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Liza Bond		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not administer residents medications
Staff did not follow Dr. orders
Residents hygiene needs not being met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to investigate the allegations above. LPA met with facility staff and explained the reason for this visit.
LPA conducted a previous visit on 5/4/21 and spoke with the administrator regarding the allegations. LPA had previously obtained copies of pertinent information related to the allegations above.

Staff did not administer resident's medications
It is alleged that facility staff did not administer resident #1 (R1) specific medication in the night time for a period of seven days. LPA reviewed R1's medication documentation. The specific medication was only prescribed to R1 on 3/30/21 and R1 moved out on 4/1/21. The two days 3/30/21 and 3/31/21 it is documented that R1 received the medication in the evening as they were supposed to. Based on the information obtained this allegation is deemed Unsubstantiated at this time.

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: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

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
	VISIT DATE: 05/21/2021

NARRATIVE

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Staff did not follow Dr. orders
It is alleged that R1 was given physician orders to wear compression socks and that the facility did not follow physician orders and have R1 wear the compression socks. LPA conducted interviews with facility staff and reviewed R1's facility file. Information obtained through record review and facility notes indicate that on some occasions R1 refused to wear the compressiont socks and on one occasion the only pair was taken home by a family member. Other times it was indicated that R1 was wearing the compression socks. Based on information obtained this allegation is deemed Unsubstantiated at this time.

Residents hygiene needs not being met
It is alleged that R1's hygiene needs were not met as evidenced by having dirty clothes, dirty hair, and long toe nails. LPA conducted an interview with facility staff and reviewed R1's facility file. Record review indicated that on a weekly basis R1 was getting their hair washed and nails trimmed in the facility salon. Documentation also indicate R1 received showers on a regular basis and would also refuse sometimes. Based on the information obtained this allegation is deemed Unsubstantiated at this time.

Exit Interview conducted. Copy of report emailed for signature.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

LIC9099 (FAS) - (06/04)

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