197609594-3-13-2024-31-AS-TAGD-D7PMSZ-20240731095246

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609594
Report Date: 03/13/2024
Date Signed: 03/13/2024 02:27:36 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
03/08/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230308135842

FACILITY NAME:	SPARR HEIGHTS ESTATES SENIOR LIVING		FACILITY NUMBER:	197609594
ADMINISTRATOR:	LEWIS, ERNEST		FACILITY TYPE:	740
ADDRESS:	2640 HONOLULU AVE		TELEPHONE:	(818) 248-6737
CITY:	MONTROSE	STATE: CA	ZIP CODE:	91020
CAPACITY:	131	CENSUS: 58	DATE:	03/13/2024
		UNANNOUNCED	TIME BEGAN:	09:19 AM
MET WITH:	Tracy Waite - Interim Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility is unsafe for residents in care due to unsecured access ways

Residents are not provided proper medication assistance

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Gary Tan and Ray Comer conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPAs met with interim Administrator Tracy Waite as the current administrator is indisposed and explained the reason for the visit.

LPAs conducted physical plant tour at around 9:40 AM, requested copies of facility documents relevant to the investigation at 10:10 AM, reviewed records between 10:30 AM to 11:40 AM and interviewed residents and staff between 12:30 PM to 2:00 PM. Regarding the allegation that Facility is unsafe for residents in care due to unsecured access ways, it was alleged that there is an issue regarding residents' safety and elopement from unsecured access ways in Memory Care Unit. LPAs observation during today's visit revealed that the access ways in the Memory Care units are secured and all the delayed egress and all safety protocol are in place. LPAs' interview with the maintenance staff at 12:30 PM also revealed that there was never an issue with the access and ingress and egress on the Memory Care Unit and never in disrepair for the last one and half year since the maintenance staff was employed. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

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-20230308135842

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SPARR HEIGHTS ESTATES SENIOR LIVING	FACILITY NUMBER: 197609594
	VISIT DATE: 03/13/2024

NARRATIVE

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(continued from LIC 9099-C)

Regarding the allegation that residents are not provided proper medication assistance, it was alleged that there were Medication errors and late Medications pass at the facility. LPAs interviewed six (6) random residents or 10% of current census today between 12:30 PM to 2:00 PM revealed that six (6) out of six (6) residents did not experience medication error nor late medication administration. Further interviews also revealed that six (6) out of six (6) residents did not witness or aware of any resident who had medication error or late medication pass. LPAs interview with two (2) Medication staff today between 12:30 PM to 2:00 PM also revealed that there was no medication error or medication late pass and/or reported for the last two (2) years that the medication staff were employed.

Based on the information gathered during this visit the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

LIC9099 (FAS) - (06/04)

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