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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609684
Report Date: 08/07/2024
Date Signed: 08/07/2024 10:24:39 AM

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
11/02/2022 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20221102123557
FACILITY NAME:SUNNYBRAE HOMEFACILITY NUMBER:
197609684
ADMINISTRATOR:SAVELLA, JEFFREYFACILITY TYPE:
740
ADDRESS:8001 SUNNYBRAE AVETELEPHONE:
(323) 455-7821
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:6CENSUS: 6DATE:
08/07/2024
UNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Josephine EspirituTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Resident had to be hospitalized due to staff neglect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegation. It was reported that Resident 1 (R1) was brought to the hospital on or around 10/29/22 for a bacterial infection and the presence of maggots to R1’s toes as a result of facility neglect. The initial visit to this investigation was made by LPA Evelin Rios on 11/02/22. The complaint was also referred to Investigations Branch (IB) on 11/02/22, and accepted as a full investigation, assigned to Investigator Brian Slatic. During the course of IB’s investigation interviews and record review were made.

IB’s Slatic’s investigation consisted of the following:
• On 11/04/22, IB conducted a review of R1’s needs and service history. R1 was admitted into facility 09/30/22. R1 was receiving medical treatment from Brandman’s Centers for Senior Care and Skirball Hospice. Wound care was being provided by Skirball Hospice. Hospice records reveal history of bacterial infection and pressure injuries.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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 2
Control Number 31-AS-20221102123557
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: SUNNYBRAE HOME
FACILITY NUMBER: 197609684
VISIT DATE: 08/07/2024
NARRATIVE
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· On 11/15/22, Hospice record review conducted. IB’s review reveal that during R1’s stay at the facility, nursing visits were made on 10/07/22, 10/12/22, 10/14/22, 10/19/22, 10/24/22, 10/28/22, 10/31/22. Client was hospitalized on 10/29/22.
· On 12/13/22, IB reviewed records from Bradman’s center, which reveal documentation of Bacterial infection prior to admission to facility. Records confirm wound care provided from 09/30/22 to 10/29/22. During Home Health Agency (HHA) visit on 10/29/22, maggots observed to R1’s toe. R1 was sent to the hospital as a result. IB’s review of records indicate that R1 continued to receive wound care services after their return from the hospital.
· On 12/13/22, IB reviewed medical records from the hospital. Record review reveal R1 arrived at the hospital on 10/29/22, and was discharged back to the facility on 11/02/22. R1 was admitted at risk for rapid decompensation due to infectious symptoms and evidence of worsening bacterial infection. On 10/31/22, treating physician recommended for surgery. On 11/02/22, Social Worker (SW) confirms R1 continued to receive daily wound care, hospice care, and weekly visits from Bradman. SW denied the maggots were due to lack of care.
· On 12/29/22, IB interviewed R1’s family who was not aware of any care concerns.
· On 01/12/23, IB interviewed the facility administrator, Jeffery Savella, Staff 1 (S1) and Staff 2 (S2).
According to the administrator, “staff are trained to observe for any obvious changes and then report to the home health nurse. As far as the administrator knows, they did not observe any such changes or issues with R1’s wound care”. Interviews with S1 and S2 confirms that they are live-in staff that helps assist with R1’s care. Both staff acknowledge R1 was receiving wound care, and they help assist the hospice nurse with the bathing and cleaning to R1, but did not see the presence of maggots to R1’s toe. Staff also indicated that their job is to visually observe for any changes between nursing visits.

Based on the information obtained by IB, R1’s conditions were chronic and existed before admission to this facility. R1 was receiving daily wound care and treatment from home health and hospice. Facility staff’s duty is to observe for any changes with R1 and report to home health, which they reported to no significant level of activity. While there was a presence of maggots to the toe area of R1, the evidence does not support that it was a result of caregiver neglect. Therefore, the allegation of staff neglect is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC9099 (FAS) - (06/04)
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