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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609759
Report Date: 03/15/2022
Date Signed: 03/15/2022 04:05:47 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
10/31/2019 and conducted by Evaluator Wendell Smith
COMPLAINT CONTROL NUMBER: 31-AS-20191031164418
FACILITY NAME:7 HILLS SENIOR LIVINGFACILITY NUMBER:
197609759
ADMINISTRATOR:SIMITYAN, ARMENUIFACILITY TYPE:
740
ADDRESS:7112 OWENS STTELEPHONE:
(818) 438-8613
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:6CENSUS: 6DATE:
03/15/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Karina Mikhakovi TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident developed unstageable pressure injury while in care.
Staff are chemically restraining resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to finish investigation into the allegation above. LPA met with facility staff and explained the reason for this visit.
It is alleged that resident #1 (R1) did not receive the proper wound treatment and due to that R1’s wounds have worsened while being in the facility. Initial visit was conducted on 11/5/2019 by LPA Pitz. During the investigation R1’s records were obtained and reviewed.

On 11-14-2019 the case was referred to Community Care Licensing Investigative Branch to request hospice and medical documentation. Records were received December 4, 2019 and subsequently reviewed.
Information obtained through a review of R1’s hospice records indicate that R1 was in a skilled nursing facility from 2/18/19 through 4/5/19 before coming to the facility. On 4/5/19, R1’s hospice plan it indicates R1 had a poor prognosis and was on hospice due to wound management and end stage dementia.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022
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-20191031164418
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: 7 HILLS SENIOR LIVING
FACILITY NUMBER: 197609759
VISIT DATE: 03/15/2022
NARRATIVE
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R1 was seeing a wound care surgeon from June 2019-October 2019 to help with the debridement of the wounds that R1 had developed. It was noted during in the Wound care notes that R1 wounds were not healing due to low calorie intake and inactive lifestyle. Review of hospice records show that hospice was coming to the facility two to three times a week along with the care R1 was receiving from the wound care surgeon. A review of the hospice records show that hospice was aware of the wounds R1 had developed and were caring for those wounds before R1 was discharged from hospice care on 10/27/19 due to R1’s family deciding to seek active treatment for R1. Based on the information obtained through a review of R1’s hospice record show that R1 was receiving treatment for their wounds and due to a decline in R1’s health the wounds began to not heal properly. Therefore due to a lack evidence to say that R1 developed unstageable pressure injuries due a lack of care by facility staff, is deemed Unsubstantiated at this time.

Staff are chemically restraining resident.
It is alleged that facility staff was over-medicating R1 to keep R1 sedated. LPA reviewed R1's hospice records and facility records. Interviews were conducted with facility staff and R1's responsible person. Information conducted from interviews reveal that there was no issue with R1 receiving the wrong dosage of medications or being given more than they were supposed to. A review of hospice records did not show any issue with R1 receiving their medication. Therefore this allegation is deemed Unsubstantiated at this time.
Exit Interview conducted.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2