197610169-3-28-2024-31-AS-MVAO-D45TLZ-20240408145018

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610169
Report Date: 03/28/2024
Date Signed: 03/28/2024 03:30:20 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
08/03/2022 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20220803130850

FACILITY NAME:	BEYOND A HOME LLC		FACILITY NUMBER:	197610169
ADMINISTRATOR:	RICHARDSON, KESHA		FACILITY TYPE:	740
ADDRESS:	6023 WEST AVE L 12		TELEPHONE:	(661) 860-5048
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	6	CENSUS: 5	DATE:	03/28/2024
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Yolanda Castaneda		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff not provided medications as prescribed.
Staff not provided medications as prescribed.
Residents not being provided adequate food service.
Resident(s) not being provided with activities.

INVESTIGATION FINDINGS:

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On 03/28/2024 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA met with the caregiver. LPA explained the purpose of this visit was to deliver the findings for this complaint.

The investigation consisted of the following: On 08/05/2022, then, LPA Ruiz conducted a physical plant tour and collected resident documentation. During the 3/27/2024 visit, interviews were attempted with all five (5) residents of which one resident was interviewed at 11:15 am. The other four (4) residents were unable to participate due to their cognitive function. LPA Spaeth interviewed a staff member (S1) working at the facility at 11:15 am until 11:40 am. LPA reviewed the residents’ medications at 11:50 am until 12:15 pm. LPA received copies of residents' records and the facility menu. LPA Spaeth interviewed two staff members as of today, 3/28/2024 at 9:30 am and at 10:00 am via phone call. LPA reviewed resident documentation at 10:20 am until 11:00 am.
Cont. on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

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-20220803130850

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: BEYOND A HOME LLC	FACILITY NUMBER: 197610169
	VISIT DATE: 03/28/2024

NARRATIVE

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The investigation revealed the following: Regarding the allegation: Staff not provided medications as prescribed. It is being alleged that a resident’s medications were not being provided in a timely manner as prescribed. LPA Spaeth interviewed one (1) out of five (5) residents who stated they received medications in a timely manner as prescribed by their physician. Three (3) out of the five (5) staff members unanimously confirmed medications are distributed in a timely manner as prescribed by the physician. Two staff members were unavailable for interviews. LPA also reviewed the medication logs for two (2) out of the five (5) residents at 10:20 am until 11:00 am and there were no errors. LPA reviewed a previous resident’s medication logs and did not observe any issues.

Regarding the allegation: Residents being left in soiled diapers. It’s being alleged a resident is left in their bed all day in their soiled diaper and developed pressure sores. The three (3) out of five (5) staff members interviewed unanimously stated a resident is never left in their soiled diaper for an entire day. All three (3) staff members confirmed they check diapered residents every two hours. During LPA’s tour of the facility, LPA checked each room and did not observe a soiled resident laying in their bed. LPA also reviewed a previous resident’s hospice records which did not state the resident had bed sores.

Regarding the allegation: Residents not being provided adequate food service. It’s being alleged that a resident was not provided enough food during lunch and asked for additional food because they were still hungry. One (1) resident out of the five (5) residents confirmed they receive enough food to eat at each meal. The resident also confirmed staff will give an additional helping if requested. All three (3) staff members out of five (5) confidently confirmed residents are provided enough food at each meal. All three stated there is never a shortage of food. During LPA’s visit on 3/27/2024, LPA observed the lunch meal consisted of ham sandwich, salad, and fruit. LPA also observed a two-day supply of perishable food and a seven-day supply of non-perishable food available at the facility.

Regarding the allegation: Resident(s) not being provided with activities. During LPA’s visit on 3/27/2024, LPA observed two residents participating in a coloring and word search activity. LPA Spaeth also observed a staff member was providing an exercise instruction to a resident. One (1) resident confirmed activities are provided every day and the three (3) out of the five (5) staff members stated various activities are provided each day.

Based on records reviewed, interviews, and LPA’s observations, the four allegations indicated above are unsubstantiated.

Exit interview conducted and a copy of the report was given.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC9099 (FAS) - (06/04)

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