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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610097
Report Date: 10/22/2024
Date Signed: 10/22/2024 02:10:47 PM

Substantiated


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
10/17/2024 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20241017163040
FACILITY NAME:SACRED HEART HOME CARE, LLCFACILITY NUMBER:
197610097
ADMINISTRATOR:BUGAY, CONSTANCIA R.FACILITY TYPE:
735
ADDRESS:28277 FOXLANE DRIVETELEPHONE:
(661) 210-8274
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY:4CENSUS: 0DATE:
10/22/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Connie Bugay & Ricardo BugayTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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1. Staff did not seek medical services to resident in care
2. Staff did not administer resident's medication as prescribed by doctor
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced complaint visit and met with direct care staff Ricardo Bugay and Administrator Connie Bugay and informed them the reason of the visit. The following was determined:

Allegation # 1: It was alleged staff did not seek medical services for client in care. During today’s visit, from 10am to 2pm, LPA interviewed staff and reviewed client records. From the information obtained, client #1 (C1) raised C1’s leg over the stairs’ banister from the 2nd floor. The Administrator yelled for C1 to stop and ran up the stairs to C1’s room. Staff #1 (S1) was on the phone with C1’s father, who told (S1) not to call 911. Although the Administrator and S1 did not contact medical services, C1’s father arrived at the facility and took C1 home. The Administrator and S1 confirmed to LPA, that medical services should have been contacted, therefore the allegation is Substantiated at this time.
Allegation # 2: It was alleged that staff did not administer client’s medication as prescribed by doctor. During today’s visit, from 10am to 2pm, LPA interviewed staff and reviewed client records. From the information
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
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 31-AS-20241017163040
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: SACRED HEART HOME CARE, LLC
FACILITY NUMBER: 197610097
VISIT DATE: 10/22/2024
NARRATIVE
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obtained, C1 is prescribed anxiety medication to stabilize C1’s mood. According to records reviewed, there were days, when staff did not administer the full dosage prescribed by the doctor, therefore, the allegation is Substantiated at this time.

Citations issued, appeal rights, exit interview and copy of report provided.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 31-AS-20241017163040
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: SACRED HEART HOME CARE, LLC
FACILITY NUMBER: 197610097
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/16/2024
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met, evidenced by, based on interviews,C1 raised leg over the stairs’ banister from the 2nd floor. C1 has a history of anxiety and
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Administrator will submit the training certificates that is required, from the (CAP) that was issued by Regional Center. Administrator has until the POC date to submit documents.
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often used the word "suicide". Staff did not contact medical services at the time of the incident. This poses as a potential health and safety risk to client's in care.
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Type B
11/16/2024
Section Cited
CCR
80075(5)(B)
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Health Related Services:(5) If the client's physician has stated in writing that the client is unable to determine his/her own need for nonprescription PRN medication...(B) Once ordered by the physician the medication is given according to the physician's directions.
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This requirement was not met, evidenced by, based on client medication record review, staff did not follow doctor's orders by not administering the full dosage prescribed for C1. This is a potential health and safety risk to clients in care.
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Administrator will submit the training certificates that is required, from the (CAP) that was issued by Regional Center. Administrator has until the POC date to submit documents.
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: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3