197610101-3-22-2023-31-AS-RRAZ-CQYP96-20230417110637

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610101
Report Date: 03/22/2023
Date Signed: 03/22/2023 09:55:07 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/22/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20221122152807

FACILITY NAME:	HAMLIN ELDER CARE		FACILITY NUMBER:	197610101
ADMINISTRATOR:	BIGORNIA, LIMA ROSE		FACILITY TYPE:	740
ADDRESS:	20300 HAMLIN ST.		TELEPHONE:	(818) 912-6289
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY:	6	CENSUS: 2	DATE:	03/22/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Delfin Billedo		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff did not prevent resident from sustaining multiple falls and injuries while in care
Staff are not meeting resident’s dietary needs
Staff denied resident from seeking medical attention
Staff are forcing resident to ask permission to use the restroom
Staff are denying resident from going outside
Staff are denying resident access to bank account information

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Mariana Agban and Michael Cava conducted a subsequent visit to the facility to conclude the investigation regarding the above allegations. LPA met with the administrator, Rose Bigornia, and advised her of the complaint. The LPA’s investigation consisted of interviews and record review.

Staff did not prevent resident from sustaining multiple falls and injuries while in care:
In regards to the allegation, it was reported that Resident 1 (R1) had several falls sustaining some bruises. There were no witnesses identified to confirm R1’s falls. Nor were there a place, date and time provided when R1’s falls could have occurred. According to the administrator, R1 is alert and active. R1 is non-ambulatory and requires the use of a wheelchair, or walker, but is not a fall risk, and has no history of falling. A review of R1’s files do not indicate a fall risk or history of falling. On January 11, 2023, LPA

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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 31-AS-20221122152807

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: HAMLIN ELDER CARE	FACILITY NUMBER: 197610101
	VISIT DATE: 03/22/2023

NARRATIVE

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conducted an interview with R1, who denies being a fall risk. R1 does not recall ever having multiple falls at the facility while in care. LPA was able to look at R1’s arms and legs and did not observe any fresh or old bruises. Based on the information obtained, there was insufficient evidence to corroborate with the allegation that staff did not prevent resident from sustaining multiple injuries due to falls. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff are not meeting resident’s dietary needs:
In regards to the allegation, it was reported that R1 requires a special diet with low sugar. Interview with the administrator reveal that R1 has diabetes. Review of R1’s medical assessment does not indicate they require a special diet. Interview made with R1 reveal that they have no complaints or concern with food served to them. R1 stated staff are aware of their diabetes and doesn’t serve them anything high in sugars and carbohydrates. Based on the information obtained, there was insufficient evidence to corroborate with the allegation of staff not meeting R1’s dietary needs. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff are denying resident from going outside/Staff denied resident from seeking medical attention:

In regards to the allegation, it was reported that R1 is not allowed to go anywhere or do anything to seek medical attention. Interviews with the administrator and staff do not corroborate with the allegations. An interview with R1 held denies the allegation of not being allowed to go out. R1 states they can leave facility to go to their medical appointment as they please, and they were never denied seeking any medical attention. R1 adds they get assistance with their medical appointments, and at times gets medical services such as podiatry in house. R1 stated they prefer to get their appointment in house. LPA conducted interviews with R1’s family and responsible person, who expressed no complaints or concerns regarding the care and supervision provided to R1. Interview with two (2) of two (2) residents also deny the allegation of not being allowed to leave the facility, or seek medical attention. Based on the information obtained, there was insufficient evidence to prove that resident was being denied to go out, and to seek medical attention. Therefore, the allegations are deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20221122152807

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: HAMLIN ELDER CARE	FACILITY NUMBER: 197610101
	VISIT DATE: 03/22/2023

NARRATIVE

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Staff are forcing resident to ask permission to ask permission to use the restroom:
In regards to the allegation, on January 11, 2023, LPA interviewed R1, who denies the allegation. R1 stated there was never any need to ask permission to use the restroom. R1 stated they can go to the bathroom on their own. Interview with two (2) of two (2) residents also deny the allegation. Both residents stated they can use the restroom without having to ask permission. Based on the information obtained, there was insufficient evidence to corroborate the allegation of residents having to ask permission to use the restroom. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff are denying resident access to bank account information:
In regards to the allegation, it was reported that staff will not give R1 any information regarding R1’s bank account. According to the administrator, R1 has a Power of Attorney (POA) responsible for their finances and fiduciary duty. Administrator stated although R1 does have access to their finances, POA has full control, and pays R1’s bills, including R1’s rent on time. LPA made contact with the POA, responsible person, and family, who all confirmed the administrator’s information. On January 11, 2023, LPA interviewed R1 who stated that they have access to some of their finances, but acknowledges that they have a POA that is in charge of their finances and fiduciary duties. Based on the information obtained, there was insufficient evidence to corroborate the allegation of resident being denied access to their bank account information. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC9099 (FAS) - (06/04)

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