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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850111
Report Date: 08/25/2023
Date Signed: 08/25/2023 06:33:03 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
08/03/2023 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20230803133832
FACILITY NAME:LEXINGTON ASSISTED LIVINGFACILITY NUMBER:
565850111
ADMINISTRATOR:ERIC TERRILLFACILITY TYPE:
740
ADDRESS:5440 RALSTON STTELEPHONE:
(805) 644-6710
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:125CENSUS: 82DATE:
08/25/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Ashley Villareal -Family AdvisorTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Staff failed to provide adequate food service
Staff failed to meet resident's medical needs
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Esther Cortez conducted an unannounced subsequent complaint visit for the above allegations. Upon arrival at 09:45 a.m., the LPA met with Family Advisor Ashley Villareal. Entrance interview conducted and the reason for the visit was explained.

On 08/09/2023, between 8:45 a.m. and 3:45 p.m., the LPA toured the physical plant with Family Advisor Ashley Villareal, obtained pertinent documents, interviewed five (5) residents, and eight (8) staff. During today’s visit, LPA Cortez along with Family Advisor Ashley Villareal toured the facility at 10:30 a.m. The LPA also conducted interviews with residents approximately between 11:00 a.m. and 12:00 p.m.; interviews with staff were conducted approximately between 12:20 p.m. and 2:30 p.m. The LPA reviewed and obtained pertinent documents at approximately 2:30 p.m.

Report will continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
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 3
Control Number 29-AS-20230803133832
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LEXINGTON ASSISTED LIVING
FACILITY NUMBER: 565850111
VISIT DATE: 08/25/2023
NARRATIVE
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It was alleged that Staff failed to provide adequate food service. It was reported that Resident #1 (R1) has missed meals periodically. The LPA interviewed staff and residents during both initial and subsequent visits. Both resident and staff interviews revealed that the facility has breakfast (7:30 a.m.-9:30 a.m.), lunch (11:30 a.m.-1:30 p.m.) and dinner (4:30 p.m.-6:30 p.m) available for residents in the dining area and can provide meal services delivered to the residents upon request. Management indicated that residents who do not want to or cannot come to the dining area will let the caregivers know what they would like to eat from the options available and the caregivers will create a meal ticket for them. Staff and resident interviews also revealed that meals are always delivered, and that meals are left in the residents’ room if they are sleeping or refuse to eat but can change their mind later. File review revealed that R1 gets their meals delivered as needed. Information gathered from interviews with R1 was inconsistent. During the initial visit, R1 stated that the facility had not provided meals once or twice. However, during the subsequent visit R1 stated that meals were provided every day and that there were no concerns. The LPA observed breakfast plates in R1’s room on both visits, and observed lunch being delivered to R1 on todays visit at 12:16 p.m. Although residents did not get their lunch at 11:30 a.m. during todays visit, meals were delivered during the allotted lunch time. Based on information gathered during the course of the investigation, the Department does not have sufficient evidence to determine staff failed to provide adequate food service. Therefore, the above all allegation is deemed UNSUBSTANTAITED at this time.

It was alleged that Staff failed to meet resident's medical needs. It was reported that Resident #1 (R1) received physical therapy (PT) one time and requested for a follow up visit, however physical therapy has not returned. The LPA interviewed staff and residents during both initial and subsequent visits. Staff interviews revealed that the facility does not provide PT, as it is provided by an outside source and only if covered by insurance. During the initial visit, Wellness director Justin Ramirez stated that R1 had received a therapy session provided by Victoria Skilled Nursing, but ultimately R1 was “dropped”. Management indicated that when a resident is given a physician’s order for PT, the facility will work with agencies to provide the care needed. Staff and resident interviews also revealed that the facility will assist with making the residents appointments, when needed, unless residents are independent and prefer to schedule them themselves. Interview with R1 revealed that they have not voiced any concerns to staff or the administrator and has not requested for assistance in scheduling appointments for PT. Furthermore, file review revealed that R1 has received three (3) PT sessions. Based on information gathered during the course of the investigation, the Department does not have sufficient evidence to determine staff failed to meet residents’ medical needs. Therefore, the above all allegation is deemed UNSUBSTANTAITED at this time.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
08/03/2023 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20230803133832

FACILITY NAME:LEXINGTON ASSISTED LIVINGFACILITY NUMBER:
565850111
ADMINISTRATOR:ERIC TERRILLFACILITY TYPE:
740
ADDRESS:5440 RALSTON STTELEPHONE:
(805) 644-6710
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:125CENSUS: 82DATE:
08/25/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Ashley Villareal -Family AdvisorTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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9
Staff failed to meet resident's hygiene needs
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Esther Cortez conducted an unannounced subsequent complaint visit for the above allegations. Upon arrival at 09:45 a.m., the LPA met with Family Advisor Ashley Villareal. Entrance interview conducted and the reason for the visit was explained.

On 08/09/2023, between 8:45 a.m. and 3:45 p.m., the LPA toured the physical plant with Family Advisor Ashley Villareal, obtained pertinent documents, interviewed five (5) residents, and eight (8) staff. During today’s visit, LPA Cortez along with Family Advisor Ashley Villareal toured the facility at 10:30 a.m. The LPA also conducted interviews with residents approximately between 11:00 a.m. and 12:00 p.m.; interviews with staff were conducted approximately between 12:20 p.m. and 2:30 p.m. The LPA reviewed and obtained pertinent documents at approximately 2:30 p.m.

Report will continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20230803133832
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEXINGTON ASSISTED LIVING
FACILITY NUMBER: 565850111
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2023
Section Cited
CCR
877464(f)(4)
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87464(f)(4) Basic Services. Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission ..., with those activities of daily living such as dressing,bathing... This requirement is not met as evidenced by:
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The Administrator agreed to do the following:
1. Will have in service training for all staff on accurately documenting their services for residents and submit proof to CCL by 9/08/2022.
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Based on the investigation, the licensee did not comply with the section cited above as R1's hygiene needs were not met, which poses a potential health and safety risk to residents 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: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20230803133832
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LEXINGTON ASSISTED LIVING
FACILITY NUMBER: 565850111
VISIT DATE: 08/25/2023
NARRATIVE
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The allegation of ‘Staff failed to meet resident's hygiene needs’ alleges that resident #1 (R1) has only received one (1) sponge bath since 6/28. The LPA interviewed staff and residents during both initial and subsequent visits. Staff interviews revealed that residents who require assistance with bathing are on a shower schedule and residents are assigned to caregivers based on assignments. It was further revealed that staff keeps record of when showers are provided for residents on the facilities online Point Click Care (PCC) application; it is documented when residents are showered or if the residents refuse services. File review revealed that R1’s admissions agreement requires two showers a week, however there is no records of R1’s shower log from 6/28/2023 until 7/25/2023, and the LPA could not verify if the resident had been showered during that time period. In addition, file review revealed that R1 had been showered every Tuesday and Thursday since 7/25/2023, however staff interviews revealed that two staff (S1, S2) denied showering R1 on certain dates reflected as showered on the log. The LPA observed S1’s entry on their PCC device for the date denied of showering R1, upon observation S1 stated they must have accidentally entered they showered R1 in error. S2 also stated they have rushed in inputting information on the PCC due to lack of time which has resulted in falsely documenting R1 had been showered. Furthermore, staff interviews revealed that it is common for staff to ask each other to enter shower logs for each other without witnessing if staff has showered the residents which can result in false documentation of residents being showered. Therefore, based on information gathered, the above allegation “Staff failed to meet resident's hygiene needs” is deemed SUBSTANTIATED at this time.

The following deficiencies were observed (See LIC 9099-D.) and cited from the CA Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted and report reviewed with Business Manager Mayra Gutierrez. A copy of the report and appeal rights were provided

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 1 of 3