197609969-2-8-2022-29-AS-KHEN-D2WUQD-20240229144655

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609969
Report Date: 02/08/2022
Date Signed: 02/08/2022 02:56:20 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/04/2022 and conducted by Evaluator Salia Walker

COMPLAINT CONTROL NUMBER: 29-AS-20220204075140

FACILITY NAME:	VALLEY VISTA SENIOR LIVING		FACILITY NUMBER:	197609969
ADMINISTRATOR:	JOLIE HIGGINS		FACILITY TYPE:	740
ADDRESS:	7040 VAN NUYS BLVD		TELEPHONE:	(818) 906-4400
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	164	CENSUS: 45	DATE:	02/08/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Becca Black, Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility is unkempt
Staff failed to provide residents with clean linens
Staff do not practice social distancing

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Salia Walker and Ashley Smith arrived unannounced at 10:30 a.m. for an initial 10-day complaint visit. The LPAs met with Executive Director Becca Black and Business Office Manager Angela Webb and explained the reason for the visit. During today’s visit, the LPAs conducted a physical plant tour with the Executive Director at 11:10 a.m., to ensure there are no health and safety hazards. From 12:10 p.m. until 1:48 p.m., the LPAs conducted interviews with six (6) facility staff.

Regarding the allegation: Facility is unkempt
It was alleged that the facility was unkempt, and that the resident toilets were allegedly ‘extremely dirty’. During the physical plant tour, the LPAs surveyed eight (8) randomly selected rooms within the Assisted Living and Memory Care unit. The rooms appeared to be clean and were well maintained. The resident restrooms were observed to be clean and free of odors. Staff interviews revealed that housekeeping staff cleans the resident rooms and bathrooms on a weekly basis. However, caregivers confirmed that if need be or an incident occurs, they will also clean the rooms.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

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 29-AS-20220204075140

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VISTA SENIOR LIVING	FACILITY NUMBER: 197609969
	VISIT DATE: 02/08/2022

NARRATIVE

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During the plant tour, the LPAs observed the common spaces to be clean and free of odors. Caregivers and housekeeping staff claimed that they clean and sanitize commonly touched surfaces throughout the day. If there are odors or unkempt surfaces detected in a resident room, residents can alert staff and the concern is managed as needed. Based on the information obtained, there is insufficient evidence to support the claim that the facility is unkempt. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff failed to provide residents with clean linens.
It was alleged that the staff did not provide residents with clean linens. During the physical plant tour, the LPAs surveyed eight (8) randomly selected rooms within the Assisted Living and Memory Care unit. The rooms appeared to be clean and were well maintained. The LPAs observed the resident bedding and at the time of the visit, three of the eight beds were stripped, as the housekeeping staff were laundering the linens. For the other rooms, the linens appeared to be clean and free of odors. Staff interviews revealed that housekeeping staff wash the linens weekly basis. However, caregivers alleged that if need be, they will wash the linens if the resident soils the linens. Based on the information obtained, there is insufficient evidence to support the claim that the staff failed to provide residents with clean linens. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff do not practice social distancing.
It was alleged that staff are not practicing social distancing. During today’s visit, the LPAs observed the staff break room and observed that tables were six feet apart, and chairs were removed from tables to encourage physical distancing. At the time of the visit, the LPAs observed three staff persons in the room, at separate tables. The LPAs also observed signs throughout the facility to promote physical distancing both in the hallways, and in the elevators. At this time, it was communicated that there are two residents that are isolated due to COVID-19. Interviews revealed that there are dedicated staff whom work with those residents. In critical staffing times, if staff had to provide care for residents whom were positive with COVID-19 and those whom were negative for COVID-19, the facility took precautions to mitigate the risk by ensuring that staff properly disposed of their Personal Protection Equipment (PPE) prior to leaving the isolation unit to avoid cross-contamination. Based on the information obtained, there is insufficient evidence to support the claim that the staff do not practice social distancing. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

LIC9099 (FAS) - (06/04)

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