565850111-9-30-2024-29-AS-KLOZ-D9M2TU-20240930174118

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850111
Report Date: 09/30/2024
Date Signed: 09/30/2024 11:35:55 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
03/01/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20230301115936

FACILITY NAME:	LEXINGTON ASSISTED LIVING		FACILITY NUMBER:	565850111
ADMINISTRATOR:	ERIC TERRILL		FACILITY TYPE:	740
ADDRESS:	5440 RALSTON ST		TELEPHONE:	(805) 644-6710
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	125	CENSUS: 57	DATE:	09/30/2024
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Jill Morris Chapman		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff did not seek medical attention of residents in care
Facility does not provide nutritious meals for residents in care
Staff do not aid resident with incontinence needs
Staff do not ensure resident's room is free from malodorous

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Esther Cortez arrived at 10:10 a.m., unannounced to conduct a subsequent complaint visit. The LPA met with Executive Director Jill Morris Chapman and explained the reason for the visit.

On 03/06/2023, LPAs Esther Cortez and Martha Arroyo conducted facility tour at 12:27pm, toured the kitchen and observed food supply at 12:32pm, conducted interviews with the interim executive director, two staff, and one resident between 12:27pm and 3:55pm. The LPAs also conducted a file review and obtained copies of resident files and other pertinent document revelant to the investigation at 1:15pm. On 03/15/2023 LPA Cortez and Teresa Camara interviewed (3) three residents at 10:04 a.m., 10:16 a.m., 11:08 a.m.; and, interviewed (3) three staff at 2:40 p.m., 2:44 p.m., and 3:34 p.m. On 09/19/2024 LPA Cortez toured the Kitchen, observed lunch in the dinining room, and interviewed six (6) residents,one (1) staff, and the Executive Director. During today's visit, LPA Cortez briefly interviewed the ED, and obtained copies of pertinent documents revelant to the investigation. Report will continue on LIC9099-C: 2nd page.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

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 4

Control Number 29-AS-20230301115936

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: LEXINGTON ASSISTED LIVING	FACILITY NUMBER: 565850111
	VISIT DATE: 09/30/2024

NARRATIVE

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On the allegations that Staff do not ensure resident's room is free from malodorous; it is the reporting parties concern that Resident #1, and Resident #2’s room reeked of urine. It was further reported that R1’s bedding, clothing and carpet were saturated with urine and the urine odor was on the walls. To investigate the allegation, interviews and physical plant tours were conducted. Staff Interviews conducted revealed that the facility had a plumbing issue in the facility during February/March of 2023 on the same floor as R1 and R2’s room and the residents had been informed that the facility was working on the situation. The LPA was given a copy of the letter that was provided to the residents. Interview with R2, conducted on 03/06/2023 in the resident’s room, revealed that their room had smelled liked pee a few days prior, that it smelled like a bathroom, and that they had been given a flyer informing them of a bathroom leak at the facility. LPA Cortez did not detect any scents or smell of urine in R1’ and R2’s apartment or from any of the rooms or common areas toured during their visits at the facility. In addition, six (6) out of (eight) 8 residents interviewed regarding this allegation revealed that they have not had any issues or concerns of urine odors in their rooms or in the facility. The other two (2) residents interviewed referred to the plumbing issue in 2023, which was resolved. Based on the information gathered, although the allegation may have happened or is valid, the above allegation is deemed UNSUBSTANTIATED at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 29-AS-20230301115936

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: LEXINGTON ASSISTED LIVING	FACILITY NUMBER: 565850111
	VISIT DATE: 09/30/2024

NARRATIVE

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Facility’s menu obtained by LPA Cortez on 02/06/2023 reflected that the facility provided a variety of food options including Vegetarian options in 2023. Menu meals included stuffed peppers over marinara, baked potato, salads, spinach & cheese tortellini among other meals. Staff interviews revealed that the facility always has alternatives if residents do not like the meal for the day, including vegetarian alternatives such as a garden burger, pasta, tofu, grilled cheese sandwiches and others. Lastly, on 09/19/2024 the LPA observed resident’s eating a variety of foods in the dining room, some were eating spaghetti with meatballs, and others a chicken salad sandwich which based on the menu could be accompany with a garden salad, soup of the day, a dessert, and a beverage. Based on the information gathered, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that "Facility does not provide nutritious meals for residents in care," is deemed UNSUBSTANTIATED at this time.

On the allegation that Staff do not aid resident with incontinence needs; it is the reporting parties concern that resident #1 and resident #2 were in need of diapers, could not leave the facility to purchase them, and nobody provided them for the residents. To investigate the allegation, LPA Cortez conducted a file review and interviews. File review revealed that according to R1 and R2's admission agreement the community shall not be responsible for furnishing or paying for any health care items or services not expressly included in the agreement, including but not limited to incontinence products under section 1.5 Services not included. Additionally, R1 and R2 were unable to leave the community unassisted according to their Physician's report (LIC602). Executive Director Jill stated that residents and or their responsible person are responsible for supplying incontinence supplies, and residents are encourage to order them from services such as Amazon. They further stated that R1' and R2's responsible person was not good at providing incontinence supplies. Staff interviews revealed that if residents run out of diapers staff will call the residents family/ responsible person for an emergency supply, or grab from the communities emergency supply that were donated. Furthermore, staff interviews revealed that staff have purchase supplies out of their own money for residents. Interview with a resident who requires incontinence supplies stated that residents provide their own supplies and did not think it would be fair for the staff to pay. Based on the information gathered, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that " Staff do not aid resident with incontinence needs," is deemed UNSUBSTANTIATED at this time.

Report will continue on LIC9099-C: 4th page.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20230301115936

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: LEXINGTON ASSISTED LIVING	FACILITY NUMBER: 565850111
	VISIT DATE: 09/30/2024

NARRATIVE

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On the allegation that Staff did not seek medical attention of residents in care: it is the reporting parties concern that Resident #1 and Resident #2 (R1, R2) did not have a doctor or medical support during the first year living at the facility. It was further reported that both residents had severe medical issues and their physical and cognitive faculties declined as nobody was taking them to the doctor or making sure they were getting all their previous medications. To investigate the allegation, LPA Cortez conducted a file review and interviews. Residential Care Facilities for the Elderly (RCFE) are non-medical facilities that are not required to have nurses or doctors on staff. Reviewed admissions agreement for R1 and R2 revealed that the residents and/or their authorized person are responsible for obtaining and paying for all health care services they require. Interview with (previous) Wellness Director revealed that if a resident needs medical attention it is protocol for the MedTech to assess the situation and make the decision to get medical help or the family if they have a Power of Attorney, depending on the situation. In addition, staff assist in arranging doctor appointments, however the Wellness Director stated that R1 and R2 did not have a doctor because they did not have insurance. Furthermore, the Wellness Director stated that they did everything they could to assist the residents and contacted the resident’s insurance to transfer it from their previous city to their current city but were having difficulties trying to assist them because they were not the resident’s family. They were able to contact other agencies, to get support for the residents. File review also revealed that the facility obtained medical attention for R2 in different occasions and submitted Incident Reports (LIC624) to CCL. Based on the information gathered, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that "Staff did not seek medical attention of residents in care,” is deemed UNSUBSTANTIATED at this time.

On the allegation that Facility does not provide nutritious meals for residents in care, it is the reporting parties concern that the food at the facility is not nutritious, that Resident #2 (R2) is vegetarian, and that staff served R2 a scoop of over cooked spinach and old rice, and R1 was given two cooked frozen fish sticks and broth. It was further reported that R1 and R2 are not getting the calories or nourishment that they need causing their health to decline since placement. To investigate the allegation, LPA Cortez conducted interviews, file review and observations. Interviews with Seven (7) out of nine (9) residents who eat at the facility revealed that the food that the community provides is nutritious, well balanced, and that there is a variety of food. Residents also revealed that the facility provides options, and if a resident does not like something they are having, they can have staff fix them something that they want to eat, like a sandwich or a salad.
Report will continue on LIC9099-C 3rd page.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

LIC9099 (FAS) - (06/04)

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