197609594-5-7-2025-31-AS-NMAN-DGNUTR-20250514155221

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609594
Report Date: 05/01/2025
Date Signed: 05/07/2025 05:50:25 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.RO, 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
04/10/2024 and conducted by Evaluator Leizl De La Cerra

COMPLAINT CONTROL NUMBER: 31-AS-20240410154700

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: 70	DATE:	05/01/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	DENISE GOTTO, Executive Director		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff do not ensure adequate care and supervision is provided to residents in care.
Staff spoke inappropriately while in front of resident.

INVESTIGATION FINDINGS:

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This is an addendum to the Licensing report previously issued on 04/15/2024.
Licensing program Analyst (LPA) Leizl DeLaCerra conducted announced subsequent visit to the facility on 05/01/25 to deliver the findings. LPA met the administrator and explained the purpose of the visit

Allegation: Staff do not ensure adequate care and supervision is provided to residents in care.
It was alleged that due to lack of supervision, resident #1 (R1) spent the night in the flooded room on 4/08/2024 and staff did not check on R1 until next morning”.
To investigate this allegation. LPA Rosaura Valenzuela conducted an initial visit and delivered findings on 4/15/2024. During LPA de la Cerra's subsequent visit, 0n 4/24/2025. LPA conducted physical plant tour, conducted record reviews and staff interviews between 10:30am to 12:00pm and 1:30pm to 3:00pm, resident interviews were conducted between 12:30pm to 1:30pm. LPA obtained the staff roster, resident list, and gathered additional documents pertaining to the investigation.
Continue to LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La Cerra	TELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

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-20240410154700

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SPARR HEIGHTS ESTATES SENIOR LIVING	FACILITY NUMBER: 197609594
	VISIT DATE: 05/01/2025

NARRATIVE

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LPA de la Cerra’s interviews with staff #2 (S2) at 11:55am revealed that R1’s care and supervision was increased due to showing some signs of decline, confusion and bladder retention problems, S1 then instructed staff members to do hourly routine check for R1.
Interviews with staff #3 (S3) at 3:05pm and phone interview with staff #4 (S4) on 4/30/25 who both were assigned on night shift (NOC) duty during April 2024 revealed that around the beginning of April, staff members were instructed to increase the routine check on R1 to every hour. Staff S3 and S4 did check in on R1 routinely every hour and the last check in would normally be at 6:00am when their shift would end. LPA de la Cerra’s interviews with staff members, staff #5 (S5) and staff #6 (S6) who were with the AM shift (starts at 6am) during April 2024 revealed that they checked in with R1 usually at 6:30am. and every hour thereafter.
Interviews with caregivers, S3, S4, S5 and S6 revealed that although the check in with R1 was hourly but most of these check-ins with R1 would not be documented in the facility’s observation log. Caregivers are instructed that there is no need to document on the observation log if there are no changes observed with the residents or if they are just sleeping..
Interviews with residents reveal that they receive sufficient care and supervision from facility staff. Furthermore, interviews with staff # S2, S3 and S7 on 4/30/25, revealed that R1 did not like wearing incontinence underwear and the incident on 4/09/24 with the broken toilet could be due to R1 attempting to flush their incontinence underwear in the toilet which would cause the toilet to overflow and malfunction.
Review of R1’s records reveal that due to R1’s change in health condition, R1’s individual service plan was modified, that facility staff will provide total assistance to R1 to ensure successful toileting. During LPA de la Cerra’s subsequent visit on 4/24/25, R1 was not available for interview, record review by LPA de la Cerra revealed the R1 no longer resides at Sparr Heights Estates Senior Living, R1’s Power of Attorney-POA moved R1 out of the facility on 3/18/2025.
Based on inspection, observations, interviews and record reviews, there is insufficient information to support this allegation.
Therefore, the allegation remains Unsubstantiated.

CONTINUE to LIC9099-C

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La Cerra	TELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240410154700

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SPARR HEIGHTS ESTATES SENIOR LIVING	FACILITY NUMBER: 197609594
	VISIT DATE: 05/01/2025

NARRATIVE

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Allegation: Staff spoke inappropriately while in front of resident.
It was alleged that while the reporting party was with R1 in R1’s room, and a female staff with hair dyed pink or purple, who is Filipino said to the reporting party that R1 is “coo coo”.

To investigate this allegation. LPA Rosaura Valenzuela conducted an initial visit and delivered findings on 4/15/2024. During LPA de la Cerra's subsequent visit, 0n 4/24/2025. LPA conducted physical plant tour, conducted record reviews and staff interviews between 10:30am to 12:00pm and 1:30pm to 3:00pm, resident interviews were conducted between 12:30pm to 1:30pm. LPA obtained the staff roster, resident list, and gathered additional documents pertaining to the investigation.
During LPA de la Cerra’s physical plant tour, LPA did not observe any staff member with hair dyed pink or purple, who is Filipino.
LPA de la Cerra’s interviews with staff #1 (S1) at 11:00am and staff #2 (S2) at 11:55am on 4/24/25 revealed that the facility did not have a Filipino staff member with hair dyed pink or purple around April 2024. Interviews with residents reveal that they have never been spoken to inappropriately by any staff members. Additionally, residents interview also revealed that no staff member ever spoke inappropriately about them in front of their family member. During LPA de la Cerra’s subsequent visit on 4/24/25, R1 was not available for interview, record review by LPA de la Cerra revealed the R1 no longer resides at Sparr Heights Estates Senior Living, R1’s Power of Attorney-POA moved R1 out of the facility on 3/18/2025.

Based on inspection, observations, interviews and record reviews, there is insufficient information to support this allegation.
Therefore, the allegation remains Unsubstantiated.

No health and safety hazards noted at the time of this visit.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La Cerra	TELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

LIC9099 (FAS) - (06/04)

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