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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608381
Report Date: 09/20/2024
Date Signed: 09/20/2024 12:16:42 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
07/17/2024 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20240717143523
FACILITY NAME:BE WELL SENIOR LIVING II INC.FACILITY NUMBER:
197608381
ADMINISTRATOR:MELNIKOV, RUSLANFACILITY TYPE:
740
ADDRESS:5711 BECKFORD AVENUETELEPHONE:
(818) 578-5839
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:6CENSUS: 6DATE:
09/20/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Irene BadaguasTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff neglect contributed to resident's death
Facility staff do not ensure facility is maintained clean
Facility staff do not properly address insects in the facility
Facility staff do not meet residents' showering needs
Facility staff do not meet residents' dietary needs
Facility staff force the residents to eat
INVESTIGATION FINDINGS:
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At 11:00 a.m. on 09/20/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with Staff #1 (S1) and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 07/18/24 and toured the facility at 10:30 a.m., interviewed staff, residents, and hospice staff between 11:00 a.m. and 2:30 p.m., and conducted a records review at 1:00 p.m. of documents pertinent to the investigation, including but not limited to hospice records, medical assessments, admission agreements, identification forms, and service plans. LPA obtained and reviewed pertinent hospital and hospice records at 1:00 p.m. on 08/30/24. Today, LPA interviewed S1 at 11:05 a.m. and Staff #2 (S2) at 11:15 a.m.

Regarding the allegation “Staff neglect contributed to resident’s death” it was alleged Resident #1 (R1) died at the hospital from choking due to staff feeding them too quickly and forcefully. Interview with the licensee at
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
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 3
Control Number 31-AS-20240717143523
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BE WELL SENIOR LIVING II INC.
FACILITY NUMBER: 197608381
VISIT DATE: 09/20/2024
NARRATIVE
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approximately 12:00 p.m. on 07/18/24 revealed S1 was assisting R1 eat breakfast during the morning of 05/02/24 when R1 began choking. Interview with S1 revealed they stopped feeding R1 immediately after choking, administered first aid, and directed S2 to call 9-1-1. Record review revealed the facility submitted an incident report for the choking incident. The report noted R1 was eating soft food in an upright position. After R1 started choking, S2 called 9-1-1 and the licensee and other staff attended to R1. Record review of staff training records revealed all staff were sufficiently trained in assisting residents with feeding and residents with difficulty swallowing. Review of R1’s service plan from 03/05/24 noted they were able to feed themselves and staff were to assist with preparing and providing meals and drinks. R1’s medical assessment indicated they were diagnosed with Alzheimer’s dementia. Review of hospital records indicated that R1 experienced pneumonitis from choking on food and vomit on 05/02/24. R1 was discharged from the hospital back to the facility on 05/08/24 with hospice care. Review of R1’s hospice records indicated that R1 exhibited “dysphagia consistent with dementia” after the incident. A death report submitted by the facility and hospice records indicated that R1 passed away on 05/10/24 due to cardiopulmonary arrest along with end stage Alzheimer’s dementia. Based on record review and interviews, facility staff did not neglect R1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Facility staff do not ensure facility is maintained clean” it was alleged placemats and bibs were unsanitary and never washed. During facility tour, LPA observed all interior surfaces to be sanitary. LPA observed residents eating lunch at approximately 11:30 a.m. on 07/18/24 with clean bibs and placemats. LPA also observed staff wiping placemats and the dining room table after lunch around 1:00 p.m. Interviews with the licensee, Staff #3 (S3) at 12:10 p.m. on 07/18/24 and Staff #4 (S4) at 12:35 p.m. on 07/18/24 revealed staff wash bibs in the laundry every day. Due to communication issues, LPA was only able to interview two (02) out of five (05) residents, Resident #2 (R2) at 11:00 a.m. on 07/18/24 and Resident #3 (R3) at 4:00 p.m. on 07/18/24. Both residents interviewed mentioned no issues with facility cleanliness. Based on observations and interviews, staff wash surfaces, placemats, and bibs every day ensuring the facility is clean. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Facility staff do not properly address insects in the facility” it was alleged the facility did not resolve an issue with ants. During facility tour, LPA observed no insects or trace of insects or vermin in the home. Interview with the licensee revealed a few ants were noticed in the past in the corners of the home but never on tables, in eating areas, or in resident rooms. Staff promptly used bug spray to kill the ants. S3 confirmed that they used bug spray to get rid of ants previously in the facility. Two (02) out of
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20240717143523
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BE WELL SENIOR LIVING II INC.
FACILITY NUMBER: 197608381
VISIT DATE: 09/20/2024
NARRATIVE
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two (02) residents interviewed confirmed they had no issue with ants or pests in the facility. Based on observations and interviews, the facility was free of insects and vermin and properly addressed past issues with insects. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Facility staff do not meet residents' showering needs” it was alleged staff do not properly shower residents. Record review of staff training records revealed all staff had been trained on resident hygiene and bathing. Interviews with R2 and R3 revealed they receive enough assistance with showering from facility staff and an outside agency. Interviews with staff and the licensee revealed the facility revealed no hygiene issues were raised by residents, family, or visitors. Residents receive shower assistance twice a week and bed baths the other five (5) days. Based on record review and interviews, the facility meets residents’ showering needs. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Facility staff do not meet residents' dietary needs” it was alleged the facility did not provide sufficient amounts of food at night. Observations from facility tours today at 11:30 a.m. and at 10:30 a.m. on 07/18/24 revealed the facility had sufficient food supplies available in the refrigerator, freezer, and pantry. Interviews with residents revealed they are fed enough and have snacks available after dinner. Interview with staff and the licensee revealed residents eat food like sandwiches, fruit, nutritional shakes, and ice cream after dinner every night. No staff have heard of any issues with insufficient food at night. Based on observations and interviews, the facility meets residents’ dietary needs. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Facility staff force the residents to eat” it was alleged staff force feed residents too quickly. Record review of staff training records revealed all staff are trained to properly assist with resident feeding needs. Record review of resident service plans and medical assessments revealed four (04) out of five (05) residents did not require assistance eating. LPA observed staff monitoring residents during lunch on 07/18/24 and assisting Resident #4 (R4) with eating. LPA did not observe staff force feeding residents. Interviews with S3 and S4 revealed most residents can feed themselves, and staff provide assistance if requested or necessary. Interview with the licensee revealed all staff monitor and assist residents with meals.

No immediate health and safety risks were observed during today’s inspection. Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3