197609098-12-8-2022-28-AS-TVAO-CMCVKE-20221222153010

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609098
Report Date: 12/08/2022
Date Signed: 12/08/2022 02:58:54 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/05/2022 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20221205071804

FACILITY NAME:	SKYHILL QUALITY LIVING #2		FACILITY NUMBER:	197609098
ADMINISTRATOR:	ARUTYUNYAN, TINA		FACILITY TYPE:	740
ADDRESS:	626 N LAMER ST		TELEPHONE:	(818) 558-5971
CITY:	BURBANK	STATE: CA	ZIP CODE:	91506
CAPACITY:	6	CENSUS: 6	DATE:	12/08/2022
		UNANNOUNCED	TIME BEGAN:	11:56 AM
MET WITH:	Elmer Malang - Caregiver		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff are not treating residents with dignity and respect.
Staff are over medicating residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA Flores met with Elmer Malang caregiver and explained the reason for the visit.

The investigation consisted of the following: LPA Flores requested copies of staff and resident roster. LPA conducted interviews with Resident #1(R1), #2(R2), #3(R3), #4(R4), #5(R5), #6(R6), administrator, staff #2(S2) and #3(S3). LPA reviewed medication for R1,R5, R6, and requested copies of physician's report, centralized stored medication records for R1, R5, R6, trainings on personal rights and medication for staff.

The investigation revealed the following: Regarding allegation: Staff are not treating residents with dignity and respect. It is alleged caregiver tossed boxes of resident's personal hygiene supplies at resident's feet while lying in bed. Interviews with residents revealed 4 out of 6 residents state staff is respectful and/or have not thrown items at them. 2 out of 6 residents were unable to answer due to cognitive skills. interviews with staff revealed 3 out of 3 staff have not witnessed or hear the residents state that staff has thrown items or been disrespectful
(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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 28-AS-20221205071804

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SKYHILL QUALITY LIVING #2	FACILITY NUMBER: 197609098
	VISIT DATE: 12/08/2022

NARRATIVE

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towards the residents. Staff's last personal training was provided on 10/21/22. During the interviews LPA observed several boxes the size of about 2 feet by 1 foot in bedroom #4(BR4) on the floor across from R5's bed against the closet. R5 stated boxes are orders place of personal items. No other boxes were observed in the facility. Personal Hygiene items are stored in closet.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation: Staff are over medicating residents. It is alleged caregiver tried to get resident to overdose by giving excess medications. Interviews with residents revealed 3 out 6 residents state that are currently receiving medication. 2 out of the 3 residents stated that they receive their medication daily and staff provide the correct amount. 1 out of the 3 residents stated staff provides the medication daily and "sometimes, too much". 3 out of 6 residents were unable to answer due to cognitive skills. LPA Flores conducted a review of medication for R1, R5, and R6 all medications listed in centralized stored medication and destroyed record were observed in resident's medication individual box. No additional medications were observed. LPA randomly reviewed prescribed medication bottles for R5 and R6 to check the quantities according to date of prescription and date of the visit. The amount of the pills in each prescription bottle were noted to match the dates. Facility does not maintain a medication sheet to track daily giving medication. Per administrator facility will implement medication sheet. Medication training on proper medication storage and administration was provided to staff on 10/21/22. During medication review a letter from R5 was observed to request a medication be provided during the night for a as needed physician's order.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Tina Arutyunyan administrator and a copy of this report was provided.

SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC9099 (FAS) - (06/04)

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