197610151-11-9-2021-31-AS-NGID-CC3U62-20220228141737

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610151
Report Date: 11/09/2021
Date Signed: 11/09/2021 01:49:09 PM

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
11/05/2021 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20211105160112

FACILITY NAME:	AEGIS LIVING GRANADA HILLS		FACILITY NUMBER:	197610151
ADMINISTRATOR:	SHENK, LANCE		FACILITY TYPE:	740
ADDRESS:	10801 LINDLEY AVE		TELEPHONE:	(818) 363-3373
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	100	CENSUS: 76	DATE:	11/09/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Kevin Ratcliffe/ Care Director		TIME COMPLETED:	01:06 PM

ALLEGATION(S):

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Resident catheter is not cleaned properly.

Staff are not working to prevent resident falls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in response to the above mentioned allegations. LPA was screened for COVID - 19 symptoms before being allowed entry. LPA was then greeted by the facility Care Director.

Allegation 1 - Resident catheter is not cleaned properly
LPA was able to interview the resident in question (R1), interview staff, and review documentation relating to this allegation. R1 was interviewed at about 10:30 AM and R1 confirmed that staff do assist with toileting and bathing needs. R1 also confirmed that staff are very thorough and gentle and that R1 has not had any issues with the catheter. A review of Home Health documentation, conducted at about 12:00 PM, indicated that home health changes the catheter monthly and the last visit was conducted on 10/30/21. Documentation reviewed, indicated that there were no signs or symptoms of infection for R1.

Continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

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-20211105160112

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: AEGIS LIVING GRANADA HILLS	FACILITY NUMBER: 197610151
	VISIT DATE: 11/09/2021

NARRATIVE

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Staff who frequently work with R1 indicated that R1 is independent and will verbally notify staff if R1 requires assistance. R1 is changed in the morning and at night by facility staff and is able to ask for assistance during the day. R1 confirmed that R1 does have sensitive skin and a rash did develop, however R1 has received medication for the rash and has not had any issues since.

Based on information gained from interviews with staff and residents, as well as a review of facility documentation, this allegation is deemed UNSUBSTANTIATED.

Allegation 2 - Staff are not working to prevent resident falls.
LPA was able to interview the resident in question (R2), additional residents, interview staff, and review documentation relating to this allegation. At 10:10 AM, LPA interviewed R2 who confirmed that R2 had slipped out of bed. R2 stated that the staff did assist R2 back to bed and used the fall pendent to get the staffs attention. At 10:20 AM, LPA tested R2's fall pendent and staff came to our location in about 2 minuets. Facility staff were interviewed at about 11:00 AM and confirmed that in-service training was recently conducted regarding the importance of positioning and transferring residents as well as an in-service on responding to resident calls. Staff also confirmed that they all must complete an in-service annually on falls and fall risks. Staff indicated that fall risk residents have pendants to call for assistance and some residents have fall bracelets that alert staff that a fall has occurred. A review of staff in-service documentation also confirmed the annual fall training's and recent in-services held. 8 residents were also randomly interviewed during todays visit and all residents confirmed that staff are fast to respond to calls from the pendents and that they did not have any concerns over the staff not being there when they need them.

Based on information gained from interviews with staff and residents, as well as a review of facility documentation, this allegation is deemed UNSUBSTANTIATED.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

LIC9099 (FAS) - (06/04)

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