197608998-4-22-2022-31-AS-CHAS-CDXVWK-20220429164803

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608998
Report Date: 04/22/2022
Date Signed: 04/22/2022 03:31:48 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/30/2020 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20201030134945

FACILITY NAME:	CANYON TRAILS AT TOPANGA SENIOR LIVING		FACILITY NUMBER:	197608998
ADMINISTRATOR:	SUSAN WEISBARTH		FACILITY TYPE:	740
ADDRESS:	7945 TOPANGA CANYON BLVD		TELEPHONE:	(818) 716-9900
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91304
CAPACITY:	120	CENSUS: 80	DATE:	04/22/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Susan Weisbarth		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Lack of care and supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to finish investigation into the allegation above. LPA met with the administrator and explained the reason for this visit.
It is alleged that facility failed to provide the proper care and supervision due to resident #1 (R1) being hospitalized on 10/27/2020. It is alleged that R1's feet were covered in bad skin tissue, was disheveled and unkempt, and facility failed to notify R1's family or physician regarding R1's condition. LPA conducted previous visits on 10/30/2020 and 5/07/2021. During those visits LPA reviewed R1's facility file and obtained copies of pertinent information. Prior to this visit LPA conducted interviews with R1's family members and obtained copies of pertinent information. During today's visit LPA reviewed R1's facility file and obtained copies of pertinent information from approximately 1-2 pm. Information obtained through interviews reveal that on 10/23/2020, R1 was not feeling well and paramedics were called for R1. When paramedics arrived they checked R1 and offered for R1 to go to the hospital for evaluation but R1 refused. LPA obtained copy of the Emergency Medical Services report which showed that R1 was seen by paramedics but refused to go to the hospital.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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 31-AS-20201030134945

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CANYON TRAILS AT TOPANGA SENIOR LIVING	FACILITY NUMBER: 197608998
	VISIT DATE: 04/22/2022

NARRATIVE

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R1's family member was informed of R1's refusal and contacted R1's primary physician who wanted R1 sent out to the hospital but was informed that R1 refused. Interviews also revealed that an appointment was made with R1's primary care physician for a follow up on R1's care and a cough R1 had developed on 10/27/2020. A review of R1's physician report and needs and service plan show that R1 did not require any assistance with bathing, dressing, or grooming and was independent in those areas. When R1 went to their appointment with their primary physician it was noted that R1 tested positive for Covid. A review of R1's facility file showed that on 10/27/2020 before going to their physician appointment R1 refused to be tested for covid at the facility. Based on the information obtained through interviews and documentation obtained this allegation is deemed Unsubstantiated at this time.
Exit interview conducted.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC9099 (FAS) - (06/04)

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