197609594-9-15-2022-31-AS-RRAZ-CJVMMF-20221004094350

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609594
Report Date: 09/15/2022
Date Signed: 09/15/2022 03:20:10 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:	09/15/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Ernest Lewis, Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Resident sustained a bruise while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela made a unannounced subsequent visit for the above noted allegation. LPA met with Executive Director Ernest Lewis and explained the reason for the visit.

It was alleged that on 02/17/2022 Resident #1 (R1) had been injured and sustained a bruise while in care. To investigate this allegation on 03/15/22 at 1:00pm and on 09/11/2022 at 11:00am, LPA inspected the facility and R1’s room. At the time of this visit between 11:15am and 12:00pm, LPA interviewed two current staff. Furthermore, LPA Valenzuela made an attempt to speak with facility staff #1 (S1) and staff #2 (S2) who were assisting R1 in the month of February 2022 and was informed that both staff no longer work at the facility. Staff interviews revealed that Resident # 1 (R1) was observed to be scratching their face all the time. R1’s nails were noted to be long and were recently trimmed by the hospice agency. Staff believe that on 02/17/2022 R1 sustained injuries, due to scratching their own face. At 12:07pm, LPA looked at two pictures that were taken of R1 after the incident. The photos appear to confirm what staff told LPA. R1’s injury
See 9099-C

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: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

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: 09/15/2022

NARRATIVE

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appeared to be a couple of scratches and not a bruise. In addition, on 09/11/2022 around 1:30pm and at the time of this visit at 1:45pm LP Valenzuela reviewed the facility internal incident log. The information revealed from the incident log is consistent with the information received from the staff.

Based on inspection, observation, interviews and record review, there is not sufficient information to support this allegation. Therefore, it is 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: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

LIC9099 (FAS) - (06/04)

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