567609978-3-6-2023-29-AS-DPEA-CQ7V9U-20230323161456

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609978
Report Date: 03/06/2023
Date Signed: 03/06/2023 11:21:34 AM

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
06/23/2022 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20220623091102

FACILITY NAME:	CYPRESS PLACE ASSISTED LIVING		FACILITY NUMBER:	567609978
ADMINISTRATOR:	GINA SALMAN		FACILITY TYPE:	740
ADDRESS:	1200 CYPRESS POINT LANE		TELEPHONE:	(805) 650-8000
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	89	CENSUS:	DATE:	03/06/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Gina Salman		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Not enough staff to meet resident's needs
Medical attention was not sought for resident in a timely manner
Incidents involving residents are not being reported
Resident's showering needs not being met
Residents are kept in the same clothing for an extended period of time

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs), Martha Arroyo and Esther Cortez conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial visit was conducted on 06/28/2022 by LPA M. Arroyo. On today’s visit, LPAs Arroyo and Cortez met with the Executive Director, Gina Salman. Entrance interview conducted.

During the initial visit on 06/28/2022, LPA Arroyo conducted a tour of the facility at 12:27 pm, conducted interviews with the Associate Executive Director, six random staff in memory care and assisted living, nine random residents in memory care and assisted living, and two resident family members. At 3:05 pm, LPA Arroyo conducted a record review of resident files and obtained copies of resident records and other pertinent documents relevant to the investigation. On 07/15/2022, LPA Arroyo also conducted an interview with a family member at 4:16 pm.

Report continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

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 4

Control Number 29-AS-20220623091102

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: CYPRESS PLACE ASSISTED LIVING	FACILITY NUMBER: 567609978
	VISIT DATE: 03/06/2023

NARRATIVE

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Report continued from LIC9099

It was alleged that there was not enough staff to meet resident’s needs. It was reported that there are only two (2) staff working per shift. A review of staff schedules and interviews conducted revealed that there are four (4) staff for the AM and two (2) staff for the PM shift for the Memory Care side every day. Additionally, staff stated monthly meeting with management were held and if there were any concerns, this would be the right place to address them because the entire management team was present. Furthermore, staff interviews revealed they do not feel the facility has a problem with staffing and stated management was good at finding coverage if and when there were call outs. Interviews with family members revealed that when visiting the facility, they have observed at least five (5) staff in the memory care unit alone assisting residents. Based on interviews conducted and records obtained and reviewed, there is insufficient evidence to support the allegation of “not enough staff to meet resident’s needs.” Therefore, this allegation is deemed Unsubstantiated at this time.

It was also alleged that medical attention was not sought for resident in a timely manner. It was reported that a resident was having a stroke, but staff hesitated and waited a few hours before calling paramedics. Record review conducted on all incident reports submitted to Community Care Licensing (CCL) by facility in 2021 revealed only one (1) incident report involving a resident being sent to the hospital due to having a stroke. Per incident report, the resident reported to staff feeling weak and having increased confusion. Staff immediately called 911 and resident was transported to the hospital shortly after. Interviews conducted with staff revealed that incidents are reported to the Med-Tech as soon as the staff is aware of any type of incident. The Med-Tech will then assess the resident and determine if 911 needs to be called. Staff will stay with the resident until the paramedics arrive and take the resident to the hospital. Interviews with family members revealed that the resident had suffered an accident on their foot and the facility has been taking care of it since it first happened. Family stated they have noticed the resident’s condition and see that it has been improving. Based on interviews conducted, there is insufficient evidence to support the allegation of “medical attention was not sought for resident in a timely manner.” Therefore, this allegation in deemed Unsubstantiated at this time.

Report will continue on LIC9099C

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20220623091102

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: CYPRESS PLACE ASSISTED LIVING	FACILITY NUMBER: 567609978
	VISIT DATE: 03/06/2023

NARRATIVE

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Continuation Report from LIC9099C

It was also alleged that incidents involving residents are not being reported. It was reported that residents have fallen, but reports are not being submitted as they should. Record review conducted on all incident reports submitted to CCL by facility revealed the facility has been actively sending incident reports to CCL on a weekly basis. Incident reports reviewed included unwitnessed falls as well as other unusual incident occurred. Interviews with staff revealed the Med-Tech is the first person that is contacted after an incident. The Med-Tech assess and evaluate the resident to determine if 911 or paramedics need to be called. Additionally, all incidents get logged in a book as soon as they are reported to the Med-Tech. Interviews conducted with family members revealed that the facility is good at communicating with them the status of the residents or if anything happens while they’re not there. Furthermore, family members stated feeling comfortable having their family in the facility as they feel the staff cares and the residents are well taken care of. Based on the information and records obtained and reviewed, there is insufficient evidence to support the allegation of “incident involving residents are not being reported.” Therefore, this allegation is deemed Unsubstantiated at this time.

It was also alleged that resident’s showering needs are not being met. It was reported that residents are not being showered. During the facility tour on 06/28/2022, the LPA did not observe any odors coming from the residents or surrounding areas while conducting interviews. Interviews conducted with staff revealed residents are scheduled to shower twice a week. However, they have had a few residents that will refuse to shower at times. Interviews also revealed that facility does not keep a log that indicates if a resident refuse to shower, but staff are good at communicating with each other if anyone refuses to take a bath. Additionally, staff stated residents are pretty good about showering twice a week for the most part. Furthermore, family members have not reported to management or staff suggesting the residents are not clean when they visit. Interviews with family members revealed they visit the facility every other day and the resident has damp hair which would suggest the resident was showered not too long ago. Additionally, family members stated the resident was clean and reported no bad odors coming from the resident or their bedrooms while visiting. Based on LPA observation and interviews conducted, there is insufficient evidence to support the allegation of “resident’s showering needs are not being met.” Therefore, this allegation in deemed Unsubstantiated at this time.

Report will continue on LIC9099C

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20220623091102

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: CYPRESS PLACE ASSISTED LIVING	FACILITY NUMBER: 567609978
	VISIT DATE: 03/06/2023

NARRATIVE

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Continuation Report from LIC9099C

It was further alleged that residents are kept in the same clothing for an extended period of time. It was reported that staff are not changing the resident’s clothes. Interviews conducted with staff revealed that residents are changed twice a day, once for bed and the other to get ready for the day. Although staff reported some residents may refuse to change out of their pajamas, they cannot force the residents to change as they cannot make the residents to do anything they do not want. Additionally, staff reported focusing on showers and changing the residents in the mornings to make sure the residents are clean for the rest of the day. Interviews with family members revealed staff assist the resident with showering twice a week, but resident is able to dress themselves and every time they have arrived at the facility, the resident is clean. Furthermore, family members stated the resident was always wearing different clothes from their last visit. Based on interviews conducted, there is insufficient evidence to support the allegation of “residents are kept in the same clothing for an extended period of time.” Therefore, this allegation in deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. Report was reviewed and a copy was issued to the Executive Director.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC9099 (FAS) - (06/04)

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