197609594-9-11-2022-31-AS-RRAZ-CJVMMG-20221004094351

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609594
Report Date: 09/11/2022
Date Signed: 09/11/2022 04:26:43 PM

Unsubstantiated

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
03/14/2022 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20220314112215

FACILITY NAME:	SPARR HEIGHTS ESTATES SENIOR LIVING		FACILITY NUMBER:	197609594
ADMINISTRATOR:	ERIKA HUGHES		FACILITY TYPE:	740
ADDRESS:	2640 HONOLULU AVE		TELEPHONE:	(818) 248-6737
CITY:	MONTROSE	STATE: CA	ZIP CODE:	91020
CAPACITY:	131	CENSUS: 64	DATE:	09/11/2022
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Veronica Sanchez, Resident Care Coordinator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not seek medical attention for resident

Staff did not notify responsible party of resident's injury.

INVESTIGATION FINDINGS:

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Licensing Program Analyst Rosaura Valenzuela conducted an unannounced subsequent visit for the above noted allegations. LPA met with Veronica Sanchez, Resident Care Coordinator The purpose of the visit was discussed.

It was reported that staff did not seek medical attention for resident #1 (R1) when they sustained an injury. On 3/15/2022 at 3:02pm, staff interviews were initiated. Interviews revealed that staff did seek medical attention for R1. Facility informed R1's primary care physician and hospice agency. On 9/11/2022 between 12:30pm and 1:30pm, LPA Valenzuela reviewed R1's records. Records reviewed confirmed what staff had told LPA, On 2/18/2022 the hospice agency staff came to the facility to assess R1. Hospice staff noted that R1 was not in distress or pain at the time. According to hospice staff the injury looked better.

Based on interview and record review there is insufficient information to support this allegation, therefore it is deemed UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2022

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-20220314112215

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: SPARR HEIGHTS ESTATES SENIOR LIVING	FACILITY NUMBER: 197609594
	VISIT DATE: 09/11/2022

NARRATIVE

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It was alleged that staff did not notify responsible party of resident's injury. To investigate this allegation, on 3/15/2022. LPA initiated staff interviews. Interviews revealed that the facility did notify R1's responsible party on the injury, within 24 hours of its occurrence. On 9/11/2022 between 12:30pm and 1:30pm R1's records were reviewed. Records reviewed confirmed what staff had told LPA, On 2/17/2022 at 3:40pm, staff spoke to R1's responsible party regarding the injury. Staff explained to responsible party the extent of the injury.

Based on interview and record review there is not sufficient information to support this allegation. Therefore, it has been deemed UNSUBSTANTIATED at this time.

No health and safety issues noted.

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

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2022

LIC9099 (FAS) - (06/04)

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