197610098-5-14-2024-31-AS-RORN-D5JKBL-20240523074539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610098
Report Date: 05/14/2024
Date Signed: 05/14/2024 02:17:42 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
08/22/2022 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20220822130646

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: 5	DATE:	05/14/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Vilbert Keshishi		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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1. Resident sustained pressure injuries while in care
2.Staff did not change resident timely

INVESTIGATION FINDINGS:

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

Allegation # 1: It was alleged that resident sustained pressure injuries while in care. On 08/26/2022 from 930am to 11am, and during today's visit, LPA conducted interviews and reviewed resident records. From the information obtained, it was revealed to LPA, that resident #1 (R1) had developed an eye infection and prescribed antibiotics. R1 developed a severe case of diarrhea that lasted over a series of months, which eventually resulted in R1 being admitted to the hospital several times and diagnosed with a bacterial infection. R1 was admitted to the facility with the infection, and staff had to continuously change R1’s diaper. Interviews revealed that the infection, caused R1’s skin to become sensitive and frail. Although it was reported R1 sustained pressure injures while in care, LPA does not have enough evidence to corroborate the allegation, therefore based on interviews, it’s Unsubstantiated at this time.

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: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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 31-AS-20220822130646

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: 05/14/2024

NARRATIVE

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Allegation # 2: It was alleged that staff did not change resident timely. On 08/26/2022 from 930am to 11am, and during today's visit, LPA conducted interviews and resident records. From the information obtained, it was revealed to LPA, that R1 had developed a severe bacterial infection that caused severe diarrhea. Prior to being admitted to the facility, R1 was retained with the infection. Interviews also revealed that the infection, caused R1 to be hospitalized several times and caused R1 to have diaper changed hourly. Although it was reported, staff did not change resident timely, LPA does not have enough evidence to corroborate the allegation, therefore based on interviews, it’s Unsubstantiated at this time.

Exit interview and copy of report provided.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC9099 (FAS) - (06/04)

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