197610211-8-21-2024-31-AS-NGID-D8LPYZ-20240829114445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610211
Report Date: 08/21/2024
Date Signed: 08/21/2024 02:41:23 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.RO, 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
08/16/2024 and conducted by Evaluator Perchui Khurshudyan

COMPLAINT CONTROL NUMBER: 31-AS-20240816081746

FACILITY NAME:	KITTRIDGE RCFE		FACILITY NUMBER:	197610211
ADMINISTRATOR:	MARTIR, FRANCIS		FACILITY TYPE:	740
ADDRESS:	20702 KITTRIDGE ST		TELEPHONE:	(818) 854-6745
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY:	6	CENSUS: 6	DATE:	08/21/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	James Olaila-Caregiver		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not meeting resident's hygiene needs.
Staff are not meeting resident's medical needs.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

At 9:45am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an unannounced initial 10 day complaint visit at this facility to investigate the above allegations. LPA met with James Olalia S2, who granted access to the facility. The House Manager Michael Custodio arrived shortly after, and LPA explained the reason for the visit. The administrator Francis Martir was unable to be present due to having an intake in her other facility.

During course of the investigation, interviews and record review were made. At 10:00am, LPA requested resident and staff roster. At 10:10am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, Personal & Incidental (P&I) Log, relevant to the investigation. At approximately 10:15am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:20am – 2:00pm, LPA interviewed the Administrator, the House Manager, two (2) staff members, six (6) out of six (6) residents, and Social Worker.
Continue On LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

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 2

Control Number 31-AS-20240816081746

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: KITTRIDGE RCFE	FACILITY NUMBER: 197610211
	VISIT DATE: 08/21/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff are not meeting resident's hygiene needs.

It was alleged that on 08/15/2024 a credible witness conducted a routine inspection at the facility and observed R1 had overgrown toenails. To investigate this allegation, LPA conducted an interview with the Administrator, House Manager, two (2) staff members, six (6) residents, R1's Social Worker. Based on today’s interview and the information gathered, R1 is overseen by Social Worker and Case Manager who are assigned to assist R1 to manage and arrange medical and dental appointments. LPA was also informed by the Administrator, Social Worker and two (2) staff members that R1 refuses to have services of any kind and prefers to have long nails and hair. Although, the facility has a in-home Podiatrist who provides services, every three (3) months, R1 continuously declines the services. Lastly, interview with R1 confirmed that the facility encourages R1 to have toe/fingernails trimmed. R1 informed LPA that it is his/her Personal Rights and cannot be violated. Therefore, based on the information received the allegation: staff are not meeting resident's hygiene needs is Unsubstantiated.

Allegation: Staff are not meeting resident's medical needs.

It was alleged that on 08/15/2024 a credible witness conducted a routine inspection at the facility and observed R1 has severely dry and peeling skin. To investigate this allegation, LPA conducted an interview with the Administrator, House Manager, two (2) staff members, six (6) residents, R1's Social Worker, and PCP Medical Office. LPA was also informed by R1's Social Worker and PCP Medical office that R1 had arranged doctor's appointment to see Primary Care Physician PCP and obtain a referral for a Podiatrist. Unfortunately, he missed the appointment and the new has been scheduled for September 12, 2024. Based on today’s interview and the information gathered, R1 is overseen by Social worker and Case Manager who are assigned and assisting R1 to manage and arrange medical and dental appointments. Therefore, based on the information received the allegation: staff are not meeting resident's medical needs is Unsubstantiated.

Exit interview conducted.

Copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2