567610046-3-30-2023-29-AS-JAPL-CTQPT2-20230714113512

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567610046
Report Date: 03/30/2023
Date Signed: 03/30/2023 05:06:35 PM

Unsubstantiated

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
11/10/2022 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20221110155812

FACILITY NAME:	HEARTLAND SENIOR LIVING AT SUNNYDALE		FACILITY NUMBER:	567610046
ADMINISTRATOR:	STRELLNER, JOHN		FACILITY TYPE:	740
ADDRESS:	704 ERRINGER RD		TELEPHONE:	(805) 306-0021
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	6	CENSUS: 4	DATE:	03/30/2023
		UNANNOUNCED	TIME BEGAN:	02:59 PM
MET WITH:	John Strellner		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Facility misrepresented an increase in resident's care needs
Facility failed to provide comfortable accomodations and furnishings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint visit regarding the above noted allegations. LPA met with administrator John Strellner and explained the reason for the visit.

On 11/10/2022, the Department received a complaint regarding the above noted allegations. On 11/18/2022, LPA conducted an initial complaint investigation visit to the facility where LPA conducted interviews with staff and a witness between 12:33 p.m. and 1:56 p.m. LPA also reviewed and obtained pertinent records at 1:30 p.m. On 3/27/2023, LPA interviewed an additional witness by phone.

Regarding the allegation the facility misrepresented an increase in resident’s care needs, the staff and witness indicated R1’s wandering behaviors had increased dramatically. Staff indicated R1 would even wander at night, getting up an estimated fifteen times per night. Staff also mentioned that after a hospital

(continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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-20221110155812

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: HEARTLAND SENIOR LIVING AT SUNNYDALE	FACILITY NUMBER: 567610046
	VISIT DATE: 03/30/2023

NARRATIVE

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(continued from 9099)

stay R1 returned with neck pain and R1’s wandering increased. They were working with R1’s physician to address R1’s wandering at night but the medications had not helped. Staff also stated R1’s incontinence care needs had increased. R1 required constant supervision due to the wandering.

LPA reviewed R1’s records to review the Appraisal/Needs and Services Plan which outlined these increases in care needs, however the licensee did not complete an updated services plan or set a meeting with R1’s responsible party (RP) to go over the increased care needs. The lack of an updated Appraisal/Needs and Services Plan has been addressed in a Case Management – Deficiencies report dated 3/30/2023.

Based on interviews with staff and a witness, R1 did have a noted increase in wandering and incontinence care needs, therefore the allegation the facility misrepresented an increase in R1’s care needs is deemed Unsubstantiated at this time.

Regarding the allegation the facility failed to provide comfortable accommodations and furnishings, the complaint specifically stated R1’s recliner was given to a new resident. Staff indicated the recliner did not belong to R1, it is a recliner in the living room for all residents. Prior to the new resident moving in, R1 did use the recliner. However, a witness indicated they would see R1 mostly wandering around the facility. Staff indicated R1 would sit in the recliner but then get right up to wander around. When the new resident was admitted, they placed the resident in the recliner when that resident wanted to be in the living room. The witness also stated they would see R1 on the couch or the occasional chair sitting next to the couch or standing by the kitchen if staff were preparing meals.

Based on interviews with staff and a witness, R1 had options for seating in the living room but frequently chose to get up and walk around the facility. The recliner in the living room is for the use of all residents and there are other seating options. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and report issued to administrator via email.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC9099 (FAS) - (06/04)

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