197609594-5-23-2024-31-AS-TAGD-D7PMSX-20240731095239

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609594
Report Date: 05/23/2024
Date Signed: 05/23/2024 02:28:21 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: 61	DATE:	05/23/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Helen Kirkorian - Business Office Manager		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are not following proper reporting requirement

Resident care needs are not being met by facility staff

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Business Office Manager Helen Kirkorian and explained the reason for the visit.

LPA conducted physical plant tour at 9:42 AM, requested copies of facility documents relevant to the investigation at 10:18 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. Regarding the allegation that resident care needs are not being met by facility staff, it was alleged that Residents are complaining about quality of care and multiple issues with resident care needs. LPA's interview with six (6) residents on 03/13/24 between 12:30 PM to 2:00 PM and another six (6) residents today between 11:00 AM to 1:00 PM revealed that twelve (12) out of twelve (12) residents or about 20% of current census stated that the staff are respectful and provide all the care that they need and the quality of care are to their satisfaction. None of the twelve (12) residents interviewed expressed any issue with care or staff at this time. (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: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

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: 05/23/2024

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that Staff are not following proper reporting requirement, it was alleged that two (2) residents were in altercation and the former Executive Director (ED) did not take the staff concern seriously and did not report to CCL. The reporting party (RP) did not provide any details of the alleged incident as to who, when and where it happened. The RP also did not provide any contact details, so no contact was made with the RP to get the details of the alleged incident that was not reported. LPA's record review today between at 1:00 PM to 1:38 PM revealed that the ED referred to on RP's report had left the facility sometime in June 2023. LPA's interview with a staff at 12:45 PM however, revealed that the only altercation happened during the time of the former ED between two (2) residents happened sometime in May of 2023. LPA's record review today between 1:00 PM to 1:38 PM revealed that the facility had submitted Unusual Incident/Injury Report (LIC 624) on 05/22/23 regarding an altercation between two (2) residents happened on 05/21/23. The incident was also reported to the local law enforcement.

Based on the information gathered during this and prior 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: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

LIC9099 (FAS) - (06/04)

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