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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609597
Report Date: 05/05/2020
Date Signed: 05/14/2020 11:21:47 AM



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
03/20/2019 and conducted by Evaluator Nichelle Gillyard
COMPLAINT CONTROL NUMBER: 31-AS-20190320170119
FACILITY NAME:BETTER DAYS ASSISTED LIVINGFACILITY NUMBER:
197609597
ADMINISTRATOR:KHECHUMYAN, GRANTFACILITY TYPE:
740
ADDRESS:19431 ENADIA WAYTELEPHONE:
(818) 800-9266
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 6DATE:
05/05/2020
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Grant Khechumyan (Administrator)TIME COMPLETED:
09:55 AM
ALLEGATION(S):
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Facility accepted resident with prohibited health condition.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nichelle Gillyard initiated a subsequent complaint visit with Administrator Grant Khechumyan at 9:35 am to deliver the findings of the above allegations. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted by Facetime video conference.
At 9:40 am LPA conducted a video tour with Administrator.
Entrance interview conducted.

On 03-29-2019 LPA conducted an initial 10 day visit. At 8:40 am and 8:55 am LPA interviewed staff. At 9:14 am, 9:26 am and 9:32 am LPA interviewed residents in care. At 9:43 am LPA conducted resident records review and at 10:57 am LPA conducted personnel records review. LPA requested copies of documentation for further review. On 03-28-2019 at 10:30 am, and 12:37 pm LPA interviewed witnesses.
On November 18, 2019 LPA Gillyard subpoenaed medical records from Providence St. Joseph Medical
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maryjo SchnitzerTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Nichelle GillyardTELEPHONE: (818) 326-5838
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2020
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 6
Control Number 31-AS-20190320170119
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: BETTER DAYS ASSISTED LIVING
FACILITY NUMBER: 197609597
VISIT DATE: 05/05/2020
NARRATIVE
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Center. Medical documentation was received on 11-29-2019 and reviewed on 12-10-2019 at 3:30 pm. Resident #1 was admitted to the hospital on 02-05-2019 and discharged to the facility on 02-08-2019. LPA reviewed the discharge summary and after review found that the resident was not discharged with any prohibited health conditions. Therefore, the allegation, ’Facility accepted resident with prohibited health condition’ is unsubstantiated.
SUPERVISOR'S NAME: Maryjo SchnitzerTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Nichelle GillyardTELEPHONE: (818) 326-5838
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
03/20/2019 and conducted by Evaluator Nichelle Gillyard
COMPLAINT CONTROL NUMBER: 31-AS-20190320170119

FACILITY NAME:BETTER DAYS ASSISTED LIVINGFACILITY NUMBER:
197609597
ADMINISTRATOR:KHECHUMYAN, GRANTFACILITY TYPE:
740
ADDRESS:19431 ENADIA WAYTELEPHONE:
(818) 800-9266
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: DATE:
05/05/2020
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Grant Khechumyan (Administrator)TIME COMPLETED:
09:55 AM
ALLEGATION(S):
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Facility staff did not dispense medication as prescribed.
Facility staff did not seek medical attention in a timely manner.
INVESTIGATION FINDINGS:
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Allegation: Facility staff did not dispense medication as prescribed.
On 03-29-2019 at 9:43 pm LPA requested the record for resident #1, however it was not available. There was no admissions agreement, physicians report, pre-placement appraisal, and no documentation of discharge summary from the hospital

The Administrator picked up the resident’s medication from CVS Pharmacy on February 10. 2019, in which the Administrator stated that he did not receive insulin. LPA requested the centrally stored medication and destruction record to review the medication which were obtained however the Administrator failed to complete one.

On 02-12-2019 resident #1’s family member called the Administrator to make sure the resident had received all medications including insulin. The Administrator had indicated that he did no have any information from the resident’s referral agency or discharge nurse that the resident was receiving insulin.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maryjo SchnitzerTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Nichelle GillyardTELEPHONE: (818) 326-5838
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 31-AS-20190320170119
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: BETTER DAYS ASSISTED LIVING
FACILITY NUMBER: 197609597
VISIT DATE: 05/05/2020
NARRATIVE
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On November 18, 2019 LPA Gillyard subpoenaed medical records from Providence St. Joseph Medical Center. Medical documentation was received on 11-29-2019 and reviewed on 12-10-2019 at 3:30 pm and 01-06-2019 at 3:43 pm. Medical documentation included discharge summary. The discharge summary included new and unchanged medications which included insulin. The Administrator failed to complete a proper preplacement appraisal with the resident, resident’s family if available and or medical professionals and asked appropriate questions to address the residents needs this would have included list of new and unchanged. As a result, the Administrator didn’t know the resident was to take insulin and failed to obtain the appropriate necessary medical assistance with insulin injections as prescribed.
Therefore, the allegation, “ Facility staff did not dispense medications as prescribed”, is substantiated.


Allegation: Facility staff did not seek medical attention in a timely manner.
On 03-29-2019 LPA conducted an initial 10 day visit. At 8:40 am and 8:55 am LPA interviewed staff. At 9:14 am, 9:26 am and 9:32 am LPA interviewed residents in care. At 9:43 am LPA conducted resident records review and at 10:57 am LPA conducted personnel records review. LPA requested copies of documentation for further review. On 03-28-2019 at 10:30 a, and 12:37 pm LPA interviewed witnesses.

On April 15, 2019 LPA Gillyard subpoenaed medical records from Providence Tarzana Medical Center. Medical documentation was received on April 22, 2019 and reviewed on April 22, 2019, 01-06-2020 and 02-04-2020 at 5:10 pm and 7:20 am. Resident #1 was admitted to the hospital on 02-12-2019 at 8:21 pm.

On 03-29-2019 at 9:43 pm LPA requested the record for resident #1, however it was not available. There was no admissions agreement, physicians report, pre-placement appraisal to address the residents needs, no ID/Emergency sheet which would include an Emergency plan for the resident and no documentation of discharge summary from the hospital when the resident first arrived on 02-08-2019 to indicate current problems.

The complainants concern is that the resident was struggling to breathe and severely dehydrated. Facility staff failed to contact 911, leaving up to the family advocate.

On 02-12-2019 on or about 6:45 pm family advocate for resident #1 arrived at the facility. The advocate was hired by the resident’s family to do a welfare check on resident. Interview with the advocate indicated that upon arrival to the home it was observed that resident #1 was in the room lying on a bed with no sheets,

SUPERVISOR'S NAME: Maryjo SchnitzerTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Nichelle GillyardTELEPHONE: (818) 326-5838
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 31-AS-20190320170119
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: BETTER DAYS ASSISTED LIVING
FACILITY NUMBER: 197609597
VISIT DATE: 05/05/2020
NARRATIVE
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pillows, or mattress pad and in what appeared to be respiratory distress and allegedly asked for help. The advocate made contact with the resident’s family to find out if it was ok to contact 911. Caregiver on duty that evening indicated that the resident did not look in distress, however in a declaration from the administrator it is noted that at 8:00 pm the resident’s condition had changed. The resident had shortness of breath and after multiple telephone calls and conversations between the advocate, family and himself(Administrator), it was decided that the resident be sent to the hospital via 911.

The resident was admitted to the hospital at 8:21 pm and upon hospital assessment was diagnosed with dehydration and high blood sugar of 707 due to long term without the use of insulin. Resident #1 was placed in ICU. The Administrator and facility caregiver on duty failed to make regular observation and obtain timely medical attention until it was brought to the attention of the family advocate. Therefore, the allegation, ’Facility staff did not seek medical attention in a timely manner', is substantiated. A civil penalty was issued for a violation which resulted in an illness to a resident in care.

The licensee was informed that a civil penalty might be assessed based on Health and Safety Code 1569.49(e).



Deficiencies and civil penalty were issued per CA code of Regulations Title 22 or Health and Safety Code. See 9099D's included with this report.

Appeal rights issued.

Exit interview conducted.

SUPERVISOR'S NAME: Maryjo SchnitzerTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Nichelle GillyardTELEPHONE: (818) 326-5838
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2020
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 31-AS-20190320170119
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: BETTER DAYS ASSISTED LIVING
FACILITY NUMBER: 197609597
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/07/2020
Section Cited
CCR
87465(a)(5)
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87465 Incidental Medical and Dental Care: (a) A plan for incidental medical care shall be developed by each facility...
(5) The licensee shall assist residents with self-administered medications as needed.

This requirement is not met as evidenced by
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The Administrator has agreed to the following:
1. The Administrator shall take state approved vendor training on Incidental Medical and Dental Care.
2. Submit the training certificate to CCL.
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Based on interviews and medical records review the facility administrator did not comply with the section above.Tthe administrator failed to assist with obtaining the appropriate necessary medical assistance with insulin as prescribed.
This is an immediate health and safety risk to the resident in care.
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Type A
05/07/2020
Section Cited
CCR
87465(a)(1)
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87465 Incidental Medical and Dental Care: (a)A plan for incidental medical care shall be developed by each facility...
(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.
This requirement is not met as evidenced by
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The Administrator has agreed to the following:
1. The Administrator and facility staff shall take state approved vendored training on incidental medical and dental care.
2. Sumbit the training certificate to CCL
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Based on interviews and medical records review the facility administrator did not comply with the section above. The Administrator failed to arrange for timely medical attention which resulted in resident #1 being admitted to ICU.

This is an immediate health and safety risk to the resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maryjo SchnitzerTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Nichelle GillyardTELEPHONE: (818) 326-5838
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2020
LIC9099 (FAS) - (06/04)
Page: 6 of 6