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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608877
Report Date: 12/18/2024
Date Signed: 12/18/2024 02:13:56 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
07/27/2023 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20230727160520
FACILITY NAME:ALORA'S HOME CARE, INC.FACILITY NUMBER:
197608877
ADMINISTRATOR:EVANGELINE DE MATAFACILITY TYPE:
740
ADDRESS:22833 FRISCA DRIVETELEPHONE:
(661) 296-3244
CITY:VALENCIASTATE: CAZIP CODE:
91354
CAPACITY:6CENSUS: 6DATE:
12/18/2024
UNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Chris Mendoza - AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Resident sustained fracture while in care

Staff handled resident in a unsafe manner

Staff did not attend to resident in a timely manner

Resident is left in soiled diapers for an extended period of time

Staff don't treat residents with dignity and respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to deliver the findings for the above allegations. LPA met with Administrator Chris Mendoza and explained the reason for the visit.

On 07/27/23, a complaint was received by the Woodland Hills Adult and Senior Care Regional Office. The complaint was referred to and accepted by Community Care Licensing Division’s Investigations Branch (IB) and assigned to IB investigator Peter Zertuche.

On 07/28/2023 at 12:59 PM, LPA initiated the complaint visit. LPA interviewed the administrator and staff and obtained copies of the facility records relevant to the investigation.

During the course of the investigation, LPA Tan interviewed the administrator and staff on 07/28/23 between 1:25 PM to 2:37 PM. (continued to LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
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-20230727160520
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: ALORA'S HOME CARE, INC.
FACILITY NUMBER: 197608877
VISIT DATE: 12/18/2024
NARRATIVE
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(continued from LIC 9099-C)

Investigator Zertuche interviewed the administrator, staff, family member, hospital and fire department and law enforcement staff on different dates and times on 08/03/23, 08/15/23, 08/29/23, 09/27/23 and 10/10/23. IB Investigator Zertuche also reviewed hospital records on 09/27/23, Los Angeles Police Department (LAPD)’s records on 09/13/23, Los Angeles Fire Department (LAFD)’s record on 09/25/23 and Los Angeles County Coroner’s record on 10/09/23.

Regarding the allegation resident sustained fracture while in care, it was alleged that due to staff neglect, R1’s arm got caught in the bedrail and then fell resulting to a fracture in R1’s collarbone. LAPD’s interview with R1 during their investigation on 07/25/23 revealed that while reaching for the remote control, R1’s arm got caught on the bedrail and then fell out the bed. Upon R1’s own admission, R1’s right arm got twisted during the incident, resulting to a fracture on R1’s collarbone. Further interviews by the police on R1 also revealed that the staff arrived quickly, freed R1’s arm and called 911. Paramedics arrived seven (7) minutes later and brought R1 to the hospital.

Regarding the allegation that staff handled resident in an unsafe manner, it was alleged that a staff leaned on R1’s right shoulder and broke R1’s collar bone when R1 fell out of bed while their right arm was entangled in the bedrail. LAPD’s interview with R1 during their investigation on 07/25/23 revealed that while reaching for the remote control, R1’s arm got caught on the bedrail and then fell out the bed. Upon R1’s own admission, R1’s right arm got twisted, resulting to a fracture on R1’s collarbone. Investigator Zertuche’s interview with the three (3) staff who were present during the incident on 07/23/23 between at approximately 5:45 AM, revealed that none of the three (3) witnessed any caregiver lean or push R1 while trying to free R1’s arm in the bedrail.

(continued to LIC 9099-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20230727160520
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: ALORA'S HOME CARE, INC.
FACILITY NUMBER: 197608877
VISIT DATE: 12/18/2024
NARRATIVE
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(continuation from LIC 9099-C)

Regarding the allegation staff did not attend to the resident in a timely manner, it was alleged that when R1 was screaming for help, it took a very long time for the staff to come. LAPD’s interview with R1 during their investigation on 07/25/23 revealed that the staff arrived quickly when R1 called for help, freed R1 and called 911. Investigator Zertuche’s interview with Staff #1 (S1), the staff on duty on 08/29/23 during the incident, revealed that upon hearing R1 asked for help, the staff immediately saw R1 and asked for assistance of the other two (2) caregivers to help.

Regarding the allegation that Resident is left in soiled diapers for an extended period of time, it was alleged that staff leave R1 in wet/soiled diapers too long. LPA's interview with two (2) long-time live-in staff today between 11:30 AM to 12:50 AM, revealed that they check on R1 every hour and change R1's diapers a minimum of four (4) times a day during daytime. Further interview also revealed that R1 is also being turned every hour and never had any bed sore while still living at the facility.

Regarding the allegation that Staff don't treat residents with dignity and respect, it was alleged that staff are bringing another resident with dementia into R1's room and offering and encouraging R1 to have sex with another resident. LPA's interview with two (2) long-time live-in staff today between 11:30 AM to 12:50 AM, revealed that they never had any resident that fit the description given by R1. Further, they denied bringing any resident to R1's room nor witnessing any other care staff bringing any resident to R1's room.

Based on the information gathered during the course of the investigation, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3