197609594-7-8-2022-31-AS-RRAZ-CLL8CJ-20221127212402

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609594
Report Date: 07/07/2022
Date Signed: 07/08/2022 10:36:29 AM

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
07/01/2022 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20220701095734

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:	07/07/2022
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Ernest Lewis, ED		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff is not providing resident’s medication as prescribed.

Resident was left in the soiled diaper for extended period of time.

Resident not being provided medical attention in a timely manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit to investigate the above noted allegations. LPA met with Ernest Lewis, Executive Director and explained the purpose of the visit.

It was reported that staff is not providing resident's medication as prescribed. To investigate this allegation on 7/07/2022 at 1:00pm, LPA Valenzuela initiated staff interviews. Interviews revealed that Resident #1 (R1) is being given their medication. At 2:15pm, LPA Valenzuela reviewed R1's Medication Administration Record (MAR) for the months of June and July of 2022. LPA did not observe any discrepancies. The M.A.R. for the month of June indicated that R1 did not receive medication from 6/12-6/20/22 due to the fact that they were not in the community. Also, one cream was not administered on 6/24 and 6/25 of 2022 because the facility had not received the medication. Besides the dates mentioned previously, according to the M.A.R. and staff interviews, R1 has been receiving their medication on a daily basis.

Continue on 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: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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 2

Control Number 31-AS-20220701095734

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: 07/07/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based on interviews, record review, and observation, this allegation has been deemed UNSUBSTANTIATED at this time.

It was alleged that Resident #1 was left in a soiled diaper for an extended period of time. To investigate this allegation on 7/07/2022 between 1:00pm and 2:00pm, LPA initiated staff interviews. Interviews revealed that R1 was not left in a soiled diaper for an extended period of time. Staff change residents' diaper three times per shift, as needed, or as requested by the residents. In addition, staff indicated that if they detect a foul odor coming from a resident that requires incontinent care, then they will change their diaper immediately.

Based on interviews, there is not sufficient information to support this allegation. Therefore, this allegation is found to be UNSUBSTANTIATED at this time.

It was reported that Resident #1 is not being provided medical attention in a timely manner. To investigate this allegation on 7/07/2022 between 1:00pm and 2:00pm, staff interviews were conducted. Interviews revealed that R1 is currently receiving Palliative Care. Staff from Palliative Care come weekly to the facility to access R1. Staff from Palliative Care did inform the facility that the ointments prescribed by the M.D. were causing more harm than good. The ointments were keeping R1's skin moist and the friction caused by R1's movements was not helping R1's skin to heal. Palliative Care staff recommended that a powder medication be given to R1 instead of a cream to help keep the skin dry, so it could heal faster.

Based on interviews and record review, there is not sufficient information to support this allegation. Therefore, this allegation is deemed to be UNSUBSTANTIATED at this time.

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: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2