197609928-9-20-2021-31-AS-NGID-C7CPL9-20210930112418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609928
Report Date: 09/20/2021
Date Signed: 09/20/2021 11:53:52 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
06/07/2021 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20210607160905

FACILITY NAME:	COVELLO TOP NOTCH CARE LLC		FACILITY NUMBER:	197609928
ADMINISTRATOR:	LOPEZ, DAVID		FACILITY TYPE:	740
ADDRESS:	18807 COVELLO STREET		TELEPHONE:	(818) 855-9615
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 3	DATE:	09/20/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	David Lopez/ Administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Severe neglect resulting in resident developing pressure injuries.
Resident was left in a soiled diaper for a long period of time.
Staff not meeting resident's needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the home in order to complete the initial complaint visit conducted on 6/8/21. LPA was greeted by facility staff and the administrator arrived a short while later at about 9:45 AM.
Allegation 1. Severe neglect resulting in resident developing pressure injuries.
On LPAs, initial visit, the LPA was able to gather pertinent documentation related to this allegation. Facility documentation revealed that the resident in question (R1) was admitted to the facility on 1/26/21 and was noted to have a stage 2 pressure injury. Resident was placed on hospice on 2/20/21 and hospice care and a wound specialist visited R1 weekly. R1 was also noted to have wounds on R1's legs and pelvis area due to a dermatological issue which causes redness and blisters. Medical documentation confirmed that this was an on going issue that R1 had and was being treated by a wound specialist and dermatologist. Interviews with R1's Power of Attorney at about 10:30 AM, also confirmed that R1 was cared for properly and the wounds were due to a continuous dermatological issue.
Continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

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-20210607160905

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: COVELLO TOP NOTCH CARE LLC	FACILITY NUMBER: 197609928
	VISIT DATE: 09/20/2021

NARRATIVE

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Interviews conducted with staff at about , 9:30 AM also indicated that there are typically about 2 staff at the home at all times and only 3 residents. Facility staff indicated that they do not feel overwhelmed and are able to meet the needs of all residents in care.
Based on medical documentation review and interviews with staff and R1's Power of Attorney, this allegation is deemed to be UNSUBSTANTIATED at this time.

Allegation 2. Resident was left in a soiled diaper for a long period of time.
At 9:30 AM, LPA began interviewing staff at the facility regarding this allegation. Staff interviewed confirmed that residents are changed first thing in the morning and before bed. Staff then stated that changes throughout the day are conducted as needed. Residents are checked throughout the day to ensure that residents are clean and dry, but there is not a set schedule for daytime changes. At 9:45AM, LPA was able to interview a private caregiver, who confirmed that staff do change residents frequently and that she has never observed any resident left in a soiled diaper for a long period of time. At 10:00 AM, LPA attempted to interview residents, however all residents interviewed were unable to answer questions due to their diagnosis. At 10:30 AM, LPA was able to speak with R1's Power of Attorney who confirmed that R1 was treated well and was not left in a soiled diaper for long periods of time.
Based on interviews with staff and R1's responsible party, this allegation is deemed UNSUBSTANTIATED at this time.

Allegation 3. Staff not meeting resident's needs.
At 9:30 AM, LPA was able to interview facility staff related to this allegation. Staff indicated that there are 2 staff available at all times to assist with the residents. Staff do not feel overwhelmed and are able to meet the needs of the residents in care. At 9:45 AM, LPA spoke with a private care giver at the facility. The private caregiver stated that she does not feel that the staff are neglecting any of the residents and that all residents needs are being met. At 10:30 AM, LPA spoke to the Power of Attorney for R1. The Power of Attorney for R1 indicated that the staff are great and that the Power of Attorney does not have any concerns regarding the treatment of the residents in care.
Based on interviews with staff and R1's responsible party, this allegation is deemed UNSUBSTANTIATED at this time

Exit Interview Conducted and report issued.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

LIC9099 (FAS) - (06/04)

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