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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850111
Report Date: 08/31/2022
Date Signed: 08/31/2022 12:02:03 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, 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
02/22/2022 and conducted by Evaluator Joann Rosales
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20220222132304
FACILITY NAME:LEXINGTON ASSISTED LIVINGFACILITY NUMBER:
565850111
ADMINISTRATOR:SANJUANA ENRIQUEZFACILITY TYPE:
740
ADDRESS:5440 RALSTON STTELEPHONE:
(805) 644-6710
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:125CENSUS: 73DATE:
08/31/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ashley VillarrealTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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9
Resident was left soiled for a long period of time.
Resident does not have access to personal possessions.
Staff did not provide meals to resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) JoAnn Rosales conducted a subsequent unannounced complaint investigation visit to deliver final investigation findings. LPA met with staff Ashley Villarreal - Community Liaison Director who is authorized to review and sign reports.

Concerns were that resident #1 (R1) was left soiled for a long period of time as R1 was observed on 2/19/22 in their bed completely soaked with urine at approximately 2 pm. Interviews conducted on 2/24/22 starting at 11:07 am and on 8/23/22 starting at 3:09 pm revealed that on 2/19/22 a little before 11 am staff went to check on R1 who was in bed and still in their pajamas. Staff stated that R1 insisted on staying in bed and did not allow staff to take of their blanket. Staff stated that they did not check to see if R1 needed any assistance with toileting. Staff left R1’s room and did not return to check on R1 for the rest of their shift. A review of R1’s facility records conducted on 08/11/22 starting at 10:17 am revealed that R1 required assistance with dressing/grooming and toileting needs. Based on interviews and documentation received the allegation resident was
Continued on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann RosalesTELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 29-AS-20220222132304
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: LEXINGTON ASSISTED LIVING
FACILITY NUMBER: 565850111
VISIT DATE: 08/31/2022
NARRATIVE
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left soiled for a long period of time is deemed substantiated at this time.

Concerns were that resident #1 (R1) does not have access to personal possessions on 2/19/22 R1 was observed without their hearing aids and they were nowhere to be found in R1’s room at approximately 2 pm and was retrieved from the medication technician who had put them in their office the prior night. Interviews conducted on 2/24/22 starting at 11:07 am and on 8/23/22 starting at 3:09 pm revealed that there was a note in the medication room which stated that it was requested by R1’s family that R1’s hearing aids be put on in the morning and taken off at night and kept in the medication room. Staff stated that they were not aware that R1 wore hearing aids. A review of R1’s facility records conducted on 08/11/22 starting at 10:17 am revealed that R1 wears hearing aids. Based on interviews and documentation received staff did not assist R1 with their hearing aids the morning of 2/19/22 as they were not aware that R1 wore hearing aids therefore, the allegation that resident does not have access to personal possessions is deemed substantiated at this time.

Concerns were that staff did not provide meals to resident #1 (R1) on 2/19/22 as R1 was asked if they had breakfast or lunch around 2 pm and they indicated that they did not. Interviews conducted on 2/24/22 starting at 11:07 am and on 8/23/22 starting at 3:09 pm revealed that on 2/19/22 a little before 11 am staff went to check on R1 and R1 insisted on staying in bed. Staff stated that they did not know if R1 had breakfast or lunch that day and are not aware of R1 receiving a meal tray for breakfast or lunch that day. A review of R1’s facility records conducted on 08/11/22 starting at 10:17 am revealed that R1 required assistance with escorts to/from dining room. Based on interviews and documentation received the allegation that staff did not provide meals to resident is deemed substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

Exit interview was conducted. Today's reports and appeals rights were reviewed and emailed to the Administrator.

SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann RosalesTELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20220222132304
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: LEXINGTON ASSISTED LIVING
FACILITY NUMBER: 565850111
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/01/2022
Section Cited
CCR
87625(b)(3)
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87625 Managed Incontinence(b)(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.


This requirement is not met as evidenced by:
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Staff stated that they will provide documentation of scheduled staff inservice on how they will ensure residents are kept clean and soil free to CCL by 9/1/22 and documentation of staff inservice to CCL by 9/12/22.
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Based on interviews and record review, the licensee did not comply with the section cited above as R1 was observed to be left soiled for an extended period of time which poses a potential health and personal rights risk to persons in care.
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Type B
09/12/2022
Section Cited
HSC
1569.269(a)(30)
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1569.269 Enumerated rights; severability (a)(30) To keep, have access to, and use their own personal possessions, including toilet articles, and to keep and be allowed to spend their own money, unless limited by statute or regulation.

This requirement is not met as evidenced by:
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Staff stated that will provide documentation of staff inservice regarding regulation 1569.269(a)(30) to CCL by 9/12/22.
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Based on interviews and record review, the licensee did not comply with the section cited above as R1 did not have access to their hearing aids which poses a potential personal rights risk to persons in care.
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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: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann RosalesTELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 29-AS-20220222132304
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: LEXINGTON ASSISTED LIVING
FACILITY NUMBER: 565850111
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/12/2022
Section Cited
CCR
87555(b)(1)
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87555 General Food Service Requirements(b)(1) Where all food is provided by the facility arrangements shall be made so that each resident has available at least three meals per day. Exceptions may be allowed on weekends and holidays providing the total daily food needs are met. Not more than fifteen...
This requirement is not met as evidenced by:
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Staff stated that they will provide documentation of staff inservice regarding regulation 87555(b)(1) to CCL by 9/12/22.
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Based on interviews, the licensee did not comply with the section cited above as breakfast and lunch was not made available to R1 on 2/19/22 which poses a potential health and personal rights risk to persons in care.
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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: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann RosalesTELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
02/22/2022 and conducted by Evaluator Joann Rosales
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20220222132304

FACILITY NAME:LEXINGTON ASSISTED LIVINGFACILITY NUMBER:
565850111
ADMINISTRATOR:SANJUANA ENRIQUEZFACILITY TYPE:
740
ADDRESS:5440 RALSTON STTELEPHONE:
(805) 644-6710
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:125CENSUS: 73DATE:
08/31/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ashley VillarrealTIME COMPLETED:
12:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident's call button is inoperable.
Resident did not receive medication in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
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10
11
12
13
Licensing Program Analyst (LPA) JoAnn Rosales conducted a subsequent unannounced complaint investigation visit to deliver final investigation findings. LPA met with with staff Ashley Villarreal - Community Liaison Director who is authorized to review and sign reports.

Concerns were that resident #1 (R1)’s call button was inoperable on 2/19/22 at or around 2 pm when pushed for assistance. Interviews conducted on 2/24/22 starting at 11:07 am and on 8/23/22 starting at 3:09 pm revealed that residents have not had any issues with their call buttons being inoperable. Staff indicated that they were not aware of R1’s call button being inoperable on 2/19/22 and it was observed to be working when staff pressed R1’s call button to check it on 2/19/22. Based on interviews the allegation that resident #1 (R1)’s call button is inoperable is deemed unsubstantiated at this time.

Continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann RosalesTELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20220222132304
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: LEXINGTON ASSISTED LIVING
FACILITY NUMBER: 565850111
VISIT DATE: 08/31/2022
NARRATIVE
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Concerns were that resident #1 (R1) did not receive medication in a timely manner on 2/19/22 as R1 was not given their lunch medication and it was already after 2 pm. Interviews conducted on 2/24/22 starting at 11:07 am and on 8/23/22 starting at 3:09 pm revealed that residents have not had any issues with receiving the medications timely. A review of R1’s medication records conducted on 08/11/22 starting at 10:17 am revealed that R1 did not have any scheduled afternoon medications. Based on interviews and record review the allegation that resident #1 (R1) did not receive medication in a timely manner is deemed unsubstantiated at this time.

Exit interview was conducted. Today's reports and appeals rights were reviewed and emailed to the Administrator

SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann RosalesTELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6