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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609532
Report Date:
05/22/2021
Date Signed:
05/23/2021 11:01:29 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:
05/22/2021
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Rita Meldonian
TIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek medical attention for the resident
Staff did not cut up residents food
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 spoke with the administrator regarding the allegations above.
Staff did not seek medical attention for resident
It is alleged that facility did not seek medical attention for resident # 1(R1) when R1's legs became swollen. LPA conducted interviews with R1's responsible person and the facility administrator. LPA also reviewed documentation from R1's facility file. Information obtained from interviews and review of R1's facility file indicate that R1 was wearing compression stockings and sometimes would refuse staff assistance with applying them which was documented. R1 was also able to communicate their needs and nothing was noted about R1 complaining about any pain with their leg. Based upon 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:
05/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/22/2021
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
3
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:
05/22/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Staff did not cut up resident's food
It is alleged that facility staff would serve R1 chicken with just a fork and would not cut it up for R1. LPA conducted interviews with R1's responsible person and facility staff. On 5/21/21 during a walk through of the memory care unit LPA observed lunch being served and did not observe any issues while residents were eating lunch. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
05/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/22/2021
LIC9099
(FAS) - (06/04)
Page:
2
of
3