561703599-1-22-2024-29-AS-DPEA-D2W8AR-20240228212109

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 561703599
Report Date: 01/22/2024
Date Signed: 01/22/2024 05:22:46 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/07/2023 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20231207133126

FACILITY NAME:	LAIGO-ZANDERS HOME FOR THE ELDERLY		FACILITY NUMBER:	561703599
ADMINISTRATOR:	NORBERTO LAIGO		FACILITY TYPE:	740
ADDRESS:	3967 EAST DOWNEY COURT		TELEPHONE:	(805) 527-3278
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY:	6	CENSUS: 5	DATE:	01/22/2024
		UNANNOUNCED	TIME BEGAN:	04:10 PM
MET WITH:	Norma Zanders / Norberto Laigo		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff does not ensure resident is allowed to attend appointments.
Staff does not ensure resident is allowed to have visitors.
Staff does not ensure resident is allowed to receive private telephone calls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent visit to the facility to issue findings for the above allegation. The initial visit was conducted on 12/11/2023 by LPA M. Arroyo. During today's visit, LPA met with Licensee, Norma Zanders and Administrators, Norberto Laigo and at this time, the reason for the visit was explained. Entrance interview.

During the initial visit on 12/11/2023, LPA Arroyo conducted a tour of the facility to ensure there were no health and safety concerns at 9:45 a.m., conducted interviews with the Licensee and Administrator at 11:30 a.m. and 2:55 p.m., conducted a file review at 10:15 a.m., and obtained copies of pertinent documents relevant to the investigation. On 01/04/2024, LPA Arroyo conducted telephonic interviews with the Reporting Party’s (RP) attorney at 2:59 p.m. and Resident #1’s (R1’s) Power of Attorney (POA) at 4:43 p.m.

(Report Continued on LIC 9099C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

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-20231207133126

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: LAIGO-ZANDERS HOME FOR THE ELDERLY	FACILITY NUMBER: 561703599
	VISIT DATE: 01/22/2024

NARRATIVE

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(Report Continued from LIC 9099...)

It was alleged that staff does not ensure resident is allowed to attend appointments. It was reported that the RP hired an attorney to meet with R1. Interviews conducted with RP’s attorney revealed that they were hired by the RP to meet with R1 to assess their current situation at the facility. Additionally, RP’s attorney stated that before heading out to meet with R1, they received a telephone call from the RP stating that R1 had left the facility due to a doctor’s appointment. RP’s attorney further added that this appointment had been scheduled between themselves and the RP and did not believe that R1 and R1’s POA were made aware. Further information obtained revealed that R1’s dental, neurologist, and family practice appointments are only scheduled by either the facility or R1’s POA. Additionally, during an interview with R1’s POA it was revealed that R1 at times refuses to go to medical appointments when they are not feeling well. However, R1’s POA feels the facility staff is providing the care and supervision R1 needs and added that the facility staff is good at communicating with them. Furthermore, R1’s POA and facility staff added that they make sure R1 follows through and attends all necessary and important appointments. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “staff does not ensure resident is allowed to attend appointments”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was alleged that staff does not ensure resident is allowed to have visitors and staff does not ensure resident is allowed to receive private telephone calls. It was reported that Resident #1’s (R1’s) Power of Attorney (POA) had placed a restraining order on several individuals to stop them from visiting R1 and the facility is also blocking and monitoring telephone calls being made to R1. Information obtained during the course of the investigation revealed R1 was admitted to the facility on 06/21/2019; and R1’s physicians report, dated 10/19/2023, listed R1’s primary diagnosis as dementia. And although R1 was identified as confused and disoriented, R1 is able to follow instructions and is able to communicate needs. Interviews conducted and records review revealed that facility staff was provided with a list of individuals that may come into the facility and visit or call R1; however, they are not allowed to take R1 out of the facility without prior permission from R1’s POA.

(Report Continued on LIC 9099C...)

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231207133126

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: LAIGO-ZANDERS HOME FOR THE ELDERLY	FACILITY NUMBER: 561703599
	VISIT DATE: 01/22/2024

NARRATIVE

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(Report Continued from LIC 9099C...)

Furthermore, although the facility had two (2) separate restraining orders on specific individuals, all other persons are being allowed to visit R1 at the facility and R1 currently has their own personal telephone line inside their bedroom. Based on the information gathered during the course of the investigation, the Department does not have sufficient evidence to support the allegations of, “staff does not ensure resident is allowed to have visitors” and “staff does not ensure resident is allowed to receive private telephone calls”. Therefore, these allegations are deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

LIC9099 (FAS) - (06/04)

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