197609568-11-1-2022-31-AS-CHAS-CLWTRW-20221208135812

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609568
Report Date: 11/01/2022
Date Signed: 11/01/2022 02:47:56 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
09/07/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20220907093630

FACILITY NAME:	BEWISE HOME		FACILITY NUMBER:	197609568
ADMINISTRATOR:	OKONKWO, CHINWEIKE		FACILITY TYPE:	740
ADDRESS:	22214 VANOWEN STREET		TELEPHONE:	(818) 300-4994
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91303
CAPACITY:	6	CENSUS: 4	DATE:	11/01/2022
		UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Rachel Akampa		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Resident suffered a stroke due to staff not administering residents medication
Staff caused injury to resident
Staff handled resident in a rough manner

INVESTIGATION FINDINGS:

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At 2:30 p.m. on 11/01/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted a subsequent, unannounced complaint visit. LPA met with staff and disclosed the reason for the visit.

The case was referred to the Investigations Branch (IB) on 09/07/2022 and was returned to the Woodland Hills South Regional Office for a full investigation. LPA conducted an initial visit on 09/08/2022 and interviewed residents and staff from 10:20 a.m. to 12:45 p.m. LPA interviewed the case manager of resident #1 (R1) on 09/13/2022 at 4:00 p.m. LPA conducted record reviews on 09/08/2022 at 10:45 a.m. and on 10/03/2022 at 2:00 p.m.

Resident suffered a stroke due to staff not administering resident’s medication
Regarding the allegation above, it was alleged the facility did not administer medication to Resident #1 (R1) which caused their stroke. From interviews, R1 claimed the facility stopped providing medication, and the resulting stress led to their stroke.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

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-20220907093630

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: BEWISE HOME	FACILITY NUMBER: 197609568
	VISIT DATE: 11/01/2022

NARRATIVE

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R1 did not remember when or where the stroke occurred. R1’s case manager noted R1 has a history of making false or exaggerated statements. No other residents reported issues with missed medications. Staff #1 (S1) stated R1 would leave the facility for days at a time without explanation. R1 would return drunk or high on drugs. S1 provided medication when R1 was present. Regarding the stroke, S1 recalled the occasion. On the morning of 06/10/2022 at approximately 6:00 a.m. S1 saw R1 sitting outside smoking a cigarette. R1 became rigid and their eyes had rolled back into their head. S1 called an ambulance for R1. Medical records from the hospital showed PCP present in R1’s urine and noted R1 had an ischemic stroke. Record review also showed R1’s history of substance abuse and multiple, consecutive days of missed medication. Based on interview and record review, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANIATED at this time.

Staff caused injury to resident
Regarding the allegation above, it was alleged S1 pushed R1 and caused bruising. From interviews, R1’s case manager revealed R1’s tendencies to make claims of physical abuse without any bruising or evidence. S1 denied ever physically abusing any residents, and all residents confirmed. From record review, two police reports were made on 07/14/2022 at 12:20 p.m. and 07/22/2022 at 11:10 a.m. The first report noted “No evidence of elder abuse” and “PR not happy at loc & requesting relocation w/ case worker”. The second report noted “No signs of evidence”. Based on interview and record review, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANIATED at this time.

Staff handled resident in a rough manner
Regarding the allegation above, it was alleged S1 put their fingers in R1’s face. From interviews, S1 claimed they never put their fingers around R1’s face. Residents denied being handled roughly by staff. R1’s case manager noted R1’s tendency to make exaggerated claims. Based on interview, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANIATED at this time.

Exit interview conducted. Copy of report and appeal rights issued.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

LIC9099 (FAS) - (06/04)

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