197609982-3-29-2023-29-AS-JAPL-CSCPGR-20230531111846

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609982
Report Date: 03/29/2023
Date Signed: 03/29/2023 03:25:49 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
03/27/2023 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20230327161826

FACILITY NAME:	PARADISE IN THE VALLEY LLC		FACILITY NUMBER:	197609982
ADMINISTRATOR:	COHEN, YEHUDA		FACILITY TYPE:	740
ADDRESS:	13530 SHERMAN WAY		TELEPHONE:	(818) 902-9501
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	46	CENSUS: 41	DATE:	03/29/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Yehuda Cohen, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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1. Staff dislocated resident's arm
2. Staff did not treat resident with dignity and respect
3. Facility is not kept clean
4. Facility is infested with scabies

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit and intially met with Evelyn Pena, Wellness Director until Yehuda Cohen, Administrator arrived. The reason for today's visit was explained.

Face to face interviews were conducted with the Administrator at 9:43am, Staff #1 at 11:48am, Staff #2 at 12:20pm and an attempted interview with Resident #2 at 11:34am. Telephone interviews were conducted with Resident #1 at 9:42am and Staff #3 at 12:54pm.

Per interviews conducted regarding Allegation #1 - Staff dislocated resident's arm - per
staff, they do not manually transfer Resident #1 to and from the bed. Resident #1 is too

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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-20230327161826

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PARADISE IN THE VALLEY LLC	FACILITY NUMBER: 197609982
	VISIT DATE: 03/29/2023

NARRATIVE

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heavy to manually transfer, even with a two men assist. Staff have to use a Hoyer lift to transfer Resident #1 from the bed to the wheelchair. Staff are not aware that Resident #1 ever sustained a dislocated shoulder. Resident #1 did not complain or mention any shoulder pain while living at the facility.

Per interviews conducted regarding Allegation #2 - Staff do not treat resident with dignity and respect. Staff stated that they do not call residents names, cuss at them or tell then that they are annoying. Staff treat residents with respect. In fact, staff all stated that Resident #1 would scream, call them names and cuss out the staff if they told Resident #1 not to smoke drugs in the bedroom or if Resident #1 brought homeless people back to the facility for overnight stays or exchanged drugs in return for televisions and refrigerators from the other residents. Resident #1 would call staff "stupid" and "dumb." Staff got to the point where they did not know how to deal with Resident #1. Three staff have quit as a result of Resident #1's behavior.

Regarding Allegation #3 - Facility is not kept clean. Per interviews conducted with staff, the bedrooms are cleaned daily and they all stated that Resident #1 was a hoarder. Resident #1 would have so many things that there was barely room to walk sometimes. Staff would clean Resident #1's bedroom and immediately after it was cleaned, Resident #1 would dirty the room. Resident would throw cigarette butts on the floor, clothing and other items.
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Regarding Allegation #4 Facility is infested with scabies. Per information obtained from staff interviews, Resident #3 went to the hospital for a fall and Resident #4 due to lack of appetite in January 2023. The facility was notified by the hospital staff that Resident #3 had scabies and that all the residents should be treated for scabies as a precautionary measure. A physicians order was obtained for Elimite and the residents were treated. The scabies incident was reported to the Health Department but no visit was conducted by the health department nurse as a result of the single case of scabies.

Based on the information received, the above allegations are all Unsubstantiated
Exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC9099 (FAS) - (06/04)

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