197609931-1-23-2024-31-AS-TAGD-D7ANTJ-20240718104446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609931
Report Date: 01/23/2024
Date Signed: 01/23/2024 02:01:52 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
08/24/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230824091140

FACILITY NAME:	KAREN'S BOARD AND CARE, INC		FACILITY NUMBER:	197609931
ADMINISTRATOR:	ZINKOFSKY, CLARITA		FACILITY TYPE:	740
ADDRESS:	17231 TUBA STREET		TELEPHONE:	(818) 216-3271
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	6	CENSUS: 5	DATE:	01/23/2024
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	CLARITA ZINKOFSKY - Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not provide medical attention to the resident in a timely manner

Facility refuses to accept the resident back from the hospital

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with the Administrator and explained the reason for the visit.

LPA conducted a physical plant tour at 9:23 AM, requested copies of facility documents relevant to the investigation at 9:50 AM and interviewed staff and residents between 10:00 AM to 12:00 PM. LPA also conducted record review at 12:15 PM. Regarding the allegation that the staff did not provide medical attention to the resident in a timely manner, it was alleged that Resident #1 (R1) was dehydrated and in questionable condition and had wounds and had been weak since getting COVID and presents with the wounds that R1 had never had before. LPA's record review today at 1:34 PM revealed that R1 was admitted at this facility on 09/22/2019 with rashes. R1's recent hospitalization record dated 08/17/23 or immediately prior to R1's transfer to another facility did not indicate any wound nor R1 was diagnosed with dehydration.
(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

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-20230824091140

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: KAREN'S BOARD AND CARE, INC	FACILITY NUMBER: 197609931
	VISIT DATE: 01/23/2024

NARRATIVE

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(continued from LIC 9099)

LPA's interview with the administrator today at 11:45 AM also revealed that R1 was not receiving hospice or home health services prior to R1's last hospitalization on 08/23/23.

Regarding the allegation that Facility refuses to accept the resident back from the hospital, it was alleged that R1's family member feels that R1 is being discriminated against for contracting COVID while at the facility as they are now refusing R1 to return. LPA's interview with the administrator on 08/30/23 at 1:05 PM and today at 11:45 AM, revealed that it was the family member who did not return R1 to the facility and moved to another facility. Further, R1 had contracted Covid initially on 08/17/23 and was brought to the hospital via 911. R1 returned the next day to the facility. R1 was again brought to the hospital on 08/23/23 due to shortness of breath, confusion, and agitation. The administrator denied refusing to accept R1 back at the facility and was willing to accept the resident but suggested R1 to be further evaluated by Kaiser Hospital due to R1's continued decline and may require hospice of home health services to attend to R1's medical needs, if any.

Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

LIC9099 (FAS) - (06/04)

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