198320375-12-4-2024-11-AS-JHAD-DD7PXS-20250123104245

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320375
Report Date: 12/04/2024
Date Signed: 12/04/2024 08:28:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/08/2024 and conducted by Evaluator Sparkle Day

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240808195102

FACILITY NAME:	CIELA		FACILITY NUMBER:	198320375
ADMINISTRATOR:	SHRAM, RONY		FACILITY TYPE:	740
ADDRESS:	17310 WEST VEREDA DELA MONTURA		TELEPHONE:	(917) 667-5303
CITY:	PACIFIC PALISADES	STATE: CA	ZIP CODE:	90272
CAPACITY:	100	CENSUS: 58	DATE:	12/04/2024
		UNANNOUNCED	TIME BEGAN:	12:17 PM
MET WITH:	Rony Shram, Executive Director		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff mismanage residents' medications.

INVESTIGATION FINDINGS:

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On todays date LPA Sparkle Day conducted a Subsequent visit to the facility regarding the above allegations and met with Rony Shram, Executive Director.
The initial 10-day visit was conducted by LPA España who also met with the Rony Shram, Executive Director (A1). LPA requested, received, and reviewed copies of the following documents: Staff and Resident Rosters, resident files which contained, Resident Appraisal RCFE (LIC 603A); Appraisal Need and Services Plan (LIC 625); Physician's Report for RCFE (LIC 602A), including specifics from Resident Medical Assessment Section 87569 and General Requirements for All (Section 87702.1); Identification and Emergency Information (LIC 601); Current admission agreement with authorized signatures, Admission (LIC 604A); Any Unusual Incident/Injury/Report (LIC 624); Centrally Stored Medication and Destruction Record (LIC 622); (Evaluation Report continues LIC 9099-C) and Register of Facility Clients/Residents (LIC 9020). An interview with the administrator( A1) ,Staff #2 - Staff #5 and residents was performed.
During this investigation R#1 - R#6 were interviewed. 6 0f 6 residents insisted that they have not had any mismanagement of their medication.
CONT on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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 11-AS-20240808195102

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: CIELA	FACILITY NUMBER: 198320375
	VISIT DATE: 12/04/2024

NARRATIVE

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6 of 6 Staff were interviewed and insisted that they have not had any mismanagement of residents' medication. LPA España conducted a comprehensive review of the medication management practices at the facility. This included an inspection of the Assisted Living (AL) cart on the second floor and the Memory Care cart on the first floor. The review focused on ensuring compliance with medication protocols and identifying any discrepancies in medication administration. Not limited to comparing the medication MAR to the actual medication for each residents. Specific findings related to each resident's medication management were documented during the tour. LPA found that for 6 of 6 residents medication distribution was in compliance and found no errors.

A review of the facility's medication training and Med -tech schedule was reviewed. LPA found that all Med- Techs have continuous monthly training on medication protocols. And Med tech staffing is adequate to provide adequate services for the residents in care.

Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove, “Staff mismanage residents' medications. ” did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to Rony Shram, Executive Director.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC9099 (FAS) - (06/04)

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