198601054-3-29-2022-28-AS-LHIS-CEHFJB-20220517043140

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601054
Report Date: 03/29/2022
Date Signed: 03/29/2022 01:54:15 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/21/2022 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220321091947

FACILITY NAME:	PARKVIEW MANOR		FACILITY NUMBER:	198601054
ADMINISTRATOR:	CHERTOK, VLADAMIR		FACILITY TYPE:	735
ADDRESS:	5055 NOVGOROD STREET		TELEPHONE:	(323) 225-4293
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90032
CAPACITY:	86	CENSUS: 75	DATE:	03/29/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Elena Novikova, Administrator		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Client has lice.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegation listed above. LPA arrived unannounced and met with Administrator Elena Novikova. The purpose of the visit was explained.

LPA Chan obtained copies of the staff roster, client roster, and Client #1’s file. LPA interviewed the Administrator, 2 Staff, and 8 Clients today.

Regarding allegation – Client has lice. It is alleged that the client has had body lice for months. LPA spoke with the Administrator Novikova who confirmed Client #1 had lice. She stated that Client #1’s body was itchy for a few weeks prior to the doctor’s appointment on 3/4/22. Client was determined to have body lice and was prescribed a topical treatment to apply from head to toe at night and then wash off in the morning and repeat in one week.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

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 28-AS-20220321091947

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PARKVIEW MANOR	FACILITY NUMBER: 198601054
	VISIT DATE: 03/29/2022

NARRATIVE

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Per the Administrator, the client initially did not want to apply the treatment but later completed the 2 rounds as indicated on the physician’s order. Administrator informed LPA that the client refused to apply the cream to certain parts of the body such as the leg and private area during the treatment. The Direct Care Staff who assisted the client with applying the cream stated that the client did the treatment twice and has not seen any more lice. Per the housekeeper, rooms are cleaned daily and no lice or bugs were seen. Staff stated they have been encouraging the client to shower more often and to keep up with good hygiene due to going out in the community. Seven (7) out of eight (8) clients have not seen or heard about client having lice at the facility. LPA inspected Client #1’s room and did not observe any lice. However, during the interview with Client #1 today, client still complained of itchiness and reddish bite marks were observed on the stomach area.

Based on LPA observations and interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 1), are being cited on the attached LIC9099D.

An exit interview was conducted. The Plan of Corrections were reviewed and developed with the Administrator. A copy of this report and appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220321091947

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PARKVIEW MANOR	FACILITY NUMBER: 198601054
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/29/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/12/2022 Section Cited CCR 80072(a)(2)	1 2 3 4 5 6 7	80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include... (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator shall conduct a thorough inspection of the client and bedroom to ensure there are no more traces of lice. The administrator shall follow up with the physician to ensure the client is cleared of lice by POC due date 4/12/22.
	8 9 10 11 12 13 14	Based on interviews and observation, Client #1 still had bite marks which appears to be from the body lice which poses a health and safety and personal rights risks to other clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

LIC9099 (FAS) - (06/04)

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