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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610043
Report Date: 12/20/2024
Date Signed: 12/20/2024 02:25:03 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
10/28/2024 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20241028155908
FACILITY NAME:MEGAN'S PLACEFACILITY NUMBER:
197610043
ADMINISTRATOR:OSBORN, ANNIEFACILITY TYPE:
740
ADDRESS:7708 ETHEL AVENUETELEPHONE:
(818) 853-7654
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 6DATE:
12/20/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Kate BorubaevaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not provide proper hygiene care for resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted a complaint visit for the above allegation. LPA arrived to the facility at 02:00 PM. LPA met with facility staff who contacted the facility Administrator Annie Osborn.Entrance interview conducted and the reason for the visit was explained.

During the initial visit on 11/01/2024, the LPA conducted a physical plant tour to ensure there are no health and safety hazards, conducted interviews with the Administrator, two (2) staff members, two (2) residents, one (1) witness and obtained copies of documents pertinent to the investigation between 09:06 AM and 12:09 PM. During a follow-up visit on 12/17/2024 between 10:53 AM and 12:15 PM, LPA conducted a brief physical plant tour and interviewed the facility Administrator and the hospice company that treated Resident #1. During today’s visit LPA delivered findings for one (1) allegation.

Continued on LIC 9099C.
Substantiated
Estimated Days of Completion: 7
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 29-AS-20241028155908
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: MEGAN'S PLACE
FACILITY NUMBER: 197610043
VISIT DATE: 12/20/2024
NARRATIVE
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The allegation of “Staff did not provide proper hygiene care for resident” alleges that facility staff did not provide proper hygiene care for resident #1 (R1) resulting in their wound becoming infested with maggots. During the 11/01/2024 visit LPA Byrne interviewed the facility Administrator who stated that due to the condition of R1 they were only able to give the resident bed baths for fear of damaging R1’s skin. Additionally, the Administrator stated that on 10/24/2024 once paramedics arrived to transport R1 they observed a maggot on R1. On 12/20/2024 LPA interviewed witness #2 (W2). W2 stated that on 10/24/2024 they observed R1’s wound to have multiple maggots inside of it. An interview with a witness #3 (W3) revealed that they observed R1’s wound to be bloody and puss filled beneath the bandage. W3 also confirmed observing the maggots on R1. Based on the information obtained during interviews there is sufficient evidence to support the allegation that Staff did not provide proper hygiene care for resident. Therefore, the allegation is deemed Substantiated at this time.

The facility Administrator was unavailable to sign this report but has designated a staff member to sign on their behalf. This report was read to the Administrator via phone call at the time it was delivered.

The following deficiency was cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20241028155908
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: MEGAN'S PLACE
FACILITY NUMBER: 197610043
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2025
Section Cited
CCR
87468.1(b)(8)
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87468.1 Personal Rights of Residents...
(b) All residents...shall be protected from all of the actions specified in this subsection...
(8) Deny or restrict medical or nonmedical care that is appropriate to a resident’s organs and bodily needs...
This requirement is not met as evidenced by:
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Licensee will submit a statement of understanding to CCLD confirming that they have read the entirety of CCR 87468.1 and that they understand the importance of seeking timely medical care and respecting resident's rights to CCLD no later than POC due date.
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Based on interviews the licensee did not comply with the section cited above as R1's facial wound became infested with maggots while in care at the facility which poses a potential health or personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3