197610098-2-13-2024-31-AS-MVAO-D3XNP5-20240402103743

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610098
Report Date: 02/13/2024
Date Signed: 02/13/2024 02:34:08 PM

Unsubstantiated

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
10/12/2021 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20211012105006

FACILITY NAME:	AFFORDABLE BOARD AND CARE INC.		FACILITY NUMBER:	197610098
ADMINISTRATOR:	KESHISHI, VILBERT		FACILITY TYPE:	740
ADDRESS:	11382 KAMLOOPS ST		TELEPHONE:	(818) 397-5690
CITY:	LAKEVIEW TERRACE	STATE: CA	ZIP CODE:	91342
CAPACITY:	6	CENSUS: 6	DATE:	02/13/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Vilbert Keshishi		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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1. Licensee did not meet resident's needs resulting in hospitalized for UTI and dehydration
2. Licensee did not observe change in condition of resident
3. Licensee did not obtain medical care for resident in care
4. Resident lost significant amount of weight
5. Licensee was unable to meet resident's care needs
6. Licensee did not assist with resident's hygiene needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Vilbert to deliver the final findings of the allegations mentioned above. The following was determined:

Allegation # 1: Licensee did not meet resident’s needs resulting in hospitalized for UTI and dehydration. On 10/21/2021, 08/26/2022, and during today’s visit, from various times, ranging from 10am to 4pm, LPA conducted interviews, and reviewed documents pertaining to the complaint. It was reported to LPA, that resident # 1 (R1) was to be admitted to the facility for only (2) weeks, until R1’s husband returned from out of town. R1’s medical condition and diagnosis was dementia, with a fully contracted body. R1’s total care was depended on staff provided all ADL’s, including feeding R1. It was reported to LPA that R1 was admitted to the facility with a foul odor from R1’s urine. Staff attempted to contact R1’s husband to inform him of the smell but was not successful. Although it was reported R1 had an UTI, it was reported R1’s UTI was due to R1’s progression with R1’s diagnosed medical condition. Through all the information obtained, LPA does not have enough evidence to prove R1 was dehydrated and had an UTI

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

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-20211012105006

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: AFFORDABLE BOARD AND CARE INC.	FACILITY NUMBER: 197610098
	VISIT DATE: 02/13/2024

NARRATIVE

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during the temporary stay at the facility. Therefore, based on interviews and documentation, the allegation is Unsubstantiated at this time.

Allegation # 2: Licensee did not observe change in condition of resident. On 10/21/2021, 08/26/2022, and during today’s visit, from various times, ranging from 10am to 4pm, LPA conducted interviews, and reviewed documents pertaining to the complaint. It was reported to LPA through interviews, R1 was admitted to the facility with a fully contracted body and had a foul odor. R1 stayed at the facility for (2) weeks, and staff took care of R1 to the best of their ability and LPA does not have enough evidence to prove otherwise, therefore based on interviews and documentation received, the allegation is Unsubstantiated at this time.

Allegation # 3: Licensee did not obtain medical care for resident in care. On 10/21/2021, 08/26/2022, and during today’s visit, from various times, ranging from 10am to 4pm, LPA conducted interviews, and reviewed documents pertaining to the complaint. Prior to R1 being admitted to the facility, the Administrator requested R1 to be taken to urgent care. R1 was taken to urgent care before being admitted. Due to R1’s medical condition, staff reported R1 had a foul odor from R1’s urine. The Administrator stated, that because R1’s was admitted for a temporary stay, there was no change in R1’s medical condition when picked up from husband. The Administrator and wife are in the medical field, and have medical knowledge and training, and both did not observe that R1 needed medication attention. Therefore, LPA does not have enough evidence to prove facility did not obtain medical care for R1. Based on interviews, the allegation is Unsubstantiated at this time.

Allegation # 4: Resident lost significant amount of weight. On 10/21/2021, 08/26/2022, and during today’s visit, from various times, ranging from 10am to 4pm, LPA conducted interviews, and reviewed documents pertaining to the complaint. It was reported to LPA R1 lost a significant amount of weight during the (2) week stay at the facility. It was also reported, that when R1 was admitted, R1 was frail and had very thin skin. There was no documentation provided to the Administrator of R1’s weight when R1 was admitted. Although it was reported and alleged that R1 lost an enormous amount of weight, LPA does not have enough evidence to prove the allegation, therefore, based on interviews and documentation, it is Unsubstantiated at this time.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 31-AS-20211012105006

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: AFFORDABLE BOARD AND CARE INC.	FACILITY NUMBER: 197610098
	VISIT DATE: 02/13/2024

NARRATIVE

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Allegation # 5: Licensee was unable to meet resident's care needs. On 10/21/2021, 08/26/2022, and during today’s visit, from various times, ranging from 10am to 4pm, LPA conducted interviews, and reviewed documents pertaining to the complaint. Although it was reported that the facility did not provide adequate care for R1, and R1 had to be hospitalized, through interviews, and observations, LPA does not have enough evidence to prove the facility is unable to meet resident’s needs. LPA has observed during various times and visits, residents and facility was clean. LPA has also observed residents eating and staff cooking meals. Therefore based on interviews and observations, the allegation is Unsubstantiated at this time.

Allegation # 6: Licensee did not assist with resident's hygiene needs. Licensee was unable to meet resident's care needs. On 10/21/2021, 08/26/2022, and during today’s visit, from various times, ranging from 10am to 4pm, LPA conducted interviews, and reviewed documents pertaining to the complaint. It was alleged that R1 was dirty and filthy when picked up by R1’s husband. R1 was taken to the hospital and was admitted for (2) days. There was no documentation provided for R1 from the hospital, alleging R1’s appearance when admitted to the hospital. Interviews reveal, residents are sponge bathed once or twice a week, including R1, during R1’s temporary stay. LPA has observed during many visits, residents were clean and staff providing appropriate care for residents. Therefore, LPA does not have enough evidence to prove facility did not assist with R1’s hygiene needs, and based on interviews and observations, the allegation is Unsubstantiated at this time.

Exit interview and copy of report provided to Administrator.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

LIC9099 (FAS) - (06/04)

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