565802454-3-16-2022-29-AS-DPEA-CCYT5U-20220329142609

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802454
Report Date: 03/16/2022
Date Signed: 03/16/2022 06:58:24 PM

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
10/30/2020 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20201030142331

FACILITY NAME:	FOOTHILLS AT SIMI VALLEY, THE		FACILITY NUMBER:	565802454
ADMINISTRATOR:	BOGOYEVAC, LEATRICE		FACILITY TYPE:	740
ADDRESS:	5300 E LOS ANGELES AVENUE		TELEPHONE:	(805) 583-3500
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY:	175	CENSUS: 85	DATE:	03/16/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Leatrice Bogoyevac		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Resident room is malodorous.
Residents needs not being met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to deliver final finding for the above allegations. LPA met with administrator and reason for visit was explained.

On 10/30/2020, the Department received information that the resident rooms smell like urine and feces due to being left in soiled diapers and soiled towels in room. It was also mentioned that food is never cut up for residents in need, therefore resident is not able to eat all their food.

Following is a summary of the investigation:

On 11/06/2020, Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the initial visit complaint investigation was conducted telephonically with staff Sahar Mosalla, Business Office Manager. Also during initial visit a virtual tour via FaceTime of the facility common areas and random resident rooms was conducted between 1pm-3:30pm. (continue)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4337
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

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 29-AS-20201030142331

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: FOOTHILLS AT SIMI VALLEY, THE	FACILITY NUMBER: 565802454
	VISIT DATE: 03/16/2022

NARRATIVE

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During the virtual tour of the resident rooms LPA also conduct random resident interviews. Interview of residents, staff and other potential witnesses was also conducted during todays visit.
Based on the interviews conducted during the course of investigation, ten (10) out of ten (10) random residents interviewed revealed that their room is kept clean and odor free since the pandemic to present; All residents interviewed did not report any issue with personal care needs. LPA attempt to interview residents in "Enliven" (Memory Care) however those residents were unable to understand/communicate with LPA.

Staff interviews revealed that resident rooms are kept clean and odor free. It was explained that if a resident has an accident then the room might smell but staff clean everything up and residents are not left in soiled clothing for a long period of time. During todays visit LPA spoke briefly with residents' visitors and it was reported that residents personal care are maintained well from back to the start of the pandemic to present. Other potential witnesses interviewed today between 12:30pm-1:30pm report no issue/concern with residents personal care needs being met.

Based on interviews conducted, there is insufficient evidence to support the allegations.
Therefore the allegations "Resident room is malodorous and Residents needs not being met" is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. A copy of the report and appeal rights were provided by email.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4337
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

LIC9099 (FAS) - (06/04)

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