197609969-7-5-2022-29-AS-JAPL-CHEP77-20220818110327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609969
Report Date: 07/05/2022
Date Signed: 07/05/2022 04:14:24 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
06/27/2022 and conducted by Evaluator Salia Walker

COMPLAINT CONTROL NUMBER: 29-AS-20220627135918

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: 60	DATE:	07/05/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Gustavo Munguia		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Unqualified adult providing care

Facility cold water pump, on 5th floor, in disrepair

Staff do not provide nutritious foods for residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Salia Walker arrived unannounced for an initial complaint inspection for the above allegation(s). The LPA met with Director of Sales and Marketing Gabi Rodriguez at 9:47 a.m., and explained the reason for the visit.

During today’s visit, the LPA conducted a physical plant tour with Gabi Rodriguez at 11:06 a.m. From 9:55 a.m. until 11:06 a.m.; and from 1:40 p.m. until 2:00 p.m., the LPA conducted interviews with four (4) facility staff. From 11:50 a.m. until 1:40 p.m., the LPA reviewed and obtained copies of documents pertinent to the investigation.

Continue on LIC9099C..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

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-20220627135918

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: 07/05/2022

NARRATIVE

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Regarding the allegation, ‘Unqualified adult providing care,’ the complainant’s concern is that there is no staff in the office or on the floor(s) since 6/26/2022. The complainant is also concerned that facility staff #1 (S1) is the only person at the facility to care for the residents.

To conduct a thorough investigation, LPA Walker attempted to contact the complainant multiple times, but did not receive a response. During the investigation, LPA Walker conducted a record review, and interviews with facility staff. Record review revealed that the facility does have staff working in the office, and on the floors before, during, and after the date of 06/26/22. Record review also revealed that S1 is qualified to provide services to the facility which were appointed upon hire. Interviews with facility staff revealed that there were staff working on the date of 06/26/22. Additionally, interviews with facility staff confirmed that the ‘staff schedule’ was accurate in reflecting which staff worked on 06/26/22.

Based on record review, and interviews which were conducted, there is insufficient evidence to support the allegation ‘Unqualified adult providing care.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

Regarding the allegation, ‘Facility cold water pump, on 5th floor, in disrepair,’ the complainant’s concern is that the facility water temperature is in disrepair.
To conduct a thorough investigation, LPA Walker attempted to contact the complainant multiple times, but did not receive a response. During the investigation, LPA Walker conducted a physical plant tour, and interviews with facility staff. During the physical plan tour from 11:10 a.m. until 11:38 a.m., a random selection of six (6) resident private restrooms were observed and water temperatures were measured. Six (6) out of six (6) resident private restrooms hot water temperatures measure between the requirement of 105 and 120 degrees Fahrenheit. Two (2) out of six (6) resident private restrooms cold water degrees elevated between 70.4 and 86.3 degrees Fahrenheit during the physical plant tour. However, there is no Title 22 Regulation section that states facility’s cold water temperature needs to measure within certain degrees in Fahrenheit. Interviews with facility staff revealed that on 06/30/22, facility staff was informed that the cold water being delivered by the faucets are not to the resident’s liking. Interviews with facility staff also confirmed that the facility contacted ‘DGK Pluming’ to schedule a visit.
Continue on LIC9099C..

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220627135918

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: 07/05/2022

NARRATIVE

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However, due to the holiday weekend the plumbing company was not able to send an inspector until today 07/05/22. At 1:27 p.m., the LPA observed one (1) staff from ‘DGK Plumbing’ on site of the facility for the inspection of the cold water pump.
Based on LPAs observations, and interviews which were conducted. Although, the facility’s cold-water pump is currently in disrepairs on the fifth floor. The facility did contact the Plumbing Company to schedule a visit for repairs. Additionally, there is no Title 22 Regulation section that states facility’s cold water temperature needs to measure within certain degrees in Fahrenheit. Therefore, no citation is warranted as the facility took immediate action in contacting the plumbing company. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

Regarding the allegation, ‘Staff do not provide nutritious foods for residents in care,’ the complainant’s concern is that the food being provided by the facility is not decent, and it is not seasoned. The complainant is also concerned that the facility food is not cooked properly; and the staff service the resident’s leftovers. Additionally, the complainant is concerned the facility serves non ripped fruits or no fruit.
During the investigation, LPA Walker conducted a physical plant tour, record review, and interviews with facility staff. During the physical plant tour, the LPA conducted a walkthrough of the facility kitchen. The LPA observed varies amounts of food, ripped fruit, species, and observed different nutritious meals being served to the residents. The LPA did not observe facility cooks serving leftovers to residents. Record review revealed that the facility provides an A La Carte Menu, Specials Menu, and a Monthly Menu. Interviews with facility staff revealed that ‘there is always something new on the Menu, every single day,’ and that the facility also provides special diets choices, and low sodium. Interviews with facility staff also revealed the facility only uses limited amounts of seasons to avoid excessive sodium, but encourages residents who like additional seasoning to bring any favorite spice. Additionally, interviews with staff revealed the facility does not serve ‘leftovers,’ and does not serve ‘non ripped fruit or no fruit’ at all.
Based on LPA’s observations, record review, and interviews which were conducted, there is insufficient evidence to support the allegation ‘Staff do not provide nutritious foods for residents in care.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.
No deficiencies cited. Exit interview conducted and a copy of the report was emailed.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC9099 (FAS) - (06/04)

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