405800577-9-3-2024-29-AS-KBUY-D9FUBB-20240925152601

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405800577
Report Date: 09/03/2024
Date Signed: 09/03/2024 01:01:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2024 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20240828153748

FACILITY NAME:	VILLAGE AT SYDNEY CREEK, THE		FACILITY NUMBER:	405800577
ADMINISTRATOR:	LIZA HIX		FACILITY TYPE:	740
ADDRESS:	1234 LAUREL LANE		TELEPHONE:	(805) 543-2350
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	84	CENSUS: 65	DATE:	09/03/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Liza Hix		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff are not following infection control protocol

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rankin conducted a visit to the facility above to conduct a required 10-day visit for a complaint. LPA met with Liza Hix and explained the purpose of the visit.

During the investigation, LPA Rankin conducted a tour all 3 memory care neighborhoods. LPA reviewed 8 resident rooms, specifically rooms where dual residents reside or rooms that were found open for residents to wander in and out of. LPA also conducted interviews with the Administrator and the Wellness Coordinator, and obtained documents of, Sydney Creek Policies, Plan for Epidemic Outbreak Mitigation and the Plan of Operation (2012).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

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 29-AS-20240828153748

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VILLAGE AT SYDNEY CREEK, THE	FACILITY NUMBER: 405800577
	VISIT DATE: 09/03/2024

NARRATIVE

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On the allegation: Staff are not following infection control protocol; it was observed by the LPA that in 6 out of the 8 rooms toured there were toothbrushes of residents being stored on the counter. These restrooms are shared between 2 residents only, and in all cases only one of the residents’ toothbrushes were out. All toothbrushes except one were out due to the family/resident requesting and providing an electronic toothbrush requiring charging.

The allegation is unsubstantiated due to there are no regulations prohibiting the storage of toothbrushes on countertops. Additionally, this practice was not addressed in the facility's mitigation or infection control plan, so it does not violate their policy.

The LPA and Administrator explored various suggestions and alternatives for providing designated storage areas in the restroom for staff and residents to keep toothbrushes in. Although Licensing cannot enforce this requirement, both the LPA and Administrator acknowledge the importance of safeguarding memory care residents from others using their personal hygiene products, within reasonable limits of the facility's ability to manage. The LPA recognizes that some residents may be more independent, and/or their families may prefer their toothbrushes to be kept in a visible location, respecting the individual's personal rights. The facility does have a policy in place that all “Bathrooms shall be checked for cleanliness throughout the day by housekeeping and Direct Care staff” allowing for possible opportunities to move toothbrushes if residents’ agree.

Exit interview conducted, copy of report given.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

LIC9099 (FAS) - (06/04)

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