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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405801283
Report Date: 02/08/2024
Date Signed: 02/08/2024 11:17:05 AM

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
02/02/2024 and conducted by Evaluator Erika Miller
COMPLAINT CONTROL NUMBER: 29-AS-20240202093908
FACILITY NAME:ALDER HOUSEFACILITY NUMBER:
405801283
ADMINISTRATOR:TODD TOSEFACILITY TYPE:
740
ADDRESS:295 ALDER STREETTELEPHONE:
(805) 489-1266
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY:32CENSUS: 23DATE:
02/08/2024
UNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Todd Tose, AdministratorTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not following infection control protocols.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Erika Miller (Miller) conducted an unannounced complaint visit and issued final findings on the allegation above. During the investigation, LPA, Miller, toured the facility and interviewed, staff, and residents on February 8, 2024, from 9:30 a.m. to 10:05 a.m. LPA also obtained and reviewed relevant documents. LPA met with Todd Tose, administrator and explained the purpose of the visit. Todd Tose reported a Covid positive case to County Public Health on January 16, 2024.

On the allegation: Staff are not following infection control protocols.
Staff 1 indicated that the facility was on lock down effective January 16, 2024 to February 5, 2024. As a result of a Covid positive patient, the infection control plan was implemented. Residents were isolated for ten days, and staff donned required PPE upon entering each room. Staff was required to wear an N95 mask throughout the duration of their shift. Staff 1 further stated that residents in isolation, that did not have ensuite facilities, were provided bedside commodes. Two residents that shared a bathroom were told to isolate and advised to use commode in room until further notice. After 8th day of isolation Resident 1 used the shared bathroom and the bathroom was immediately cleaned. Resident 3 did not leave isolation until February 2, 2024, and did not use the shared the bathroom during the isolation period. Staff 2 stated that they worked during the period of January 17, 2024 to January 22, 2024. During this time the infection control plan was implemented; rooms and bathrooms were cleaned daily and doorknobs were frequently wiped. Staff 2 did not observe either Resident 1 or Resident 3 leave their rooms during this isolation period and were advised to use their bedside commodes.

Resident 1 stated that “lockdown” occurred about one week ago. During this period, meals were delivered, and extra cleaning was performed. Resident 1 stated that a bedside commode was made available during the isolation period. Resident 2 stated that they were advised to isolate in their room, but was able to go outdoors and walk. The infection control protocols precluded residents from congregating. Resident 2 observed more cleaning and disinfecting than usual and that Staff were wearing gloves and masks. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of report issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Erika MillerTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
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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