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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609889
Report Date: 04/03/2024
Date Signed: 04/03/2024 03:31:49 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
10/20/2023 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20231020083303
FACILITY NAME:PEARL OF WEST HILLS, INCFACILITY NUMBER:
197609889
ADMINISTRATOR:IRINA, KARBACHINSKIYFACILITY TYPE:
740
ADDRESS:23427 VICTORY BLVDTELEPHONE:
(818) 854-6306
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 4DATE:
04/03/2024
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Irina KarbachinskiyTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Staff did not follow resident's care plan.
Staff did not give resident medication as prescribed.
Facility night staff were not available to assist the resident.
Staff did not properly handle resident's medication.
Staff did not meet resident's hygiene needs.
INVESTIGATION FINDINGS:
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At 3:10 p.m. on 04/03/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with the licensee and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 10/24/2023 and toured the facility at 10:30 a.m., reviewed pertinent records at 10:40 a.m. of pertinent records including but not limited to the resident list, staff list, medical assessment, and hospital records, and interviewed Staff #1 (S1) at 10:50 a.m. and the licensee at approximately 12:00 p.m. LPA conducted a subsequent visit on 03/20/2024 and interviewed the licensee at 9:45 a.m. and two (02) out of three (03) residents at 3:45 p.m. and toured the facility at 10:15 a.m. Today, LPA toured the facility at 3:15 p.m.

Regarding the allegation “Staff did not follow resident's care plan” it was alleged staff did not turn Resident #1 (R1) as instructed on their care plan. Interview with S1 revealed they turned R1 whenever they requested and R1 could turn themselves as well.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
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-20231020083303
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: PEARL OF WEST HILLS, INC
FACILITY NUMBER: 197609889
VISIT DATE: 04/03/2024
NARRATIVE
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Interview with the licensee revealed R1 did not like to be rotated often due to pain, but staff rotated R1 approximately every two (02) to three (03) hours. Residents interviewed revealed they had no concerns with the care provided by the facility. Based on interviews, staff repositioned R1 sufficiently. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff did not give resident medication as prescribed” it was alleged staff provided R1 double doses of medication. Interviews with S1, the licensee, and residents confirmed the facility does not provide double doses of medications. Staff provide medications at the time prescribed and follow physician orders for “as needed” medications. No residents reported any issues with receiving incorrect amounts of medications. Based on interviews, staff did not provide R1 with double doses of medication. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Facility night staff were not available to assist the resident” it was alleged staff “was asleep upstairs” and unable to assist R1 at night. Interview with S1 revealed they are on-call at night and available to assist residents if needed. Interview with the licensee confirmed they and S1 assist residents at night if needed. S1 and the licensee further clarified that the facility does not have an upstairs. Interview with residents confirmed staff are available to assist them at night. Residents had no issues receiving care at night. Based on interviews, staff were available to help residents at night. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff did not properly handle resident's medication” it was alleged staff left R1’s medication out and accessible on their nightstand. Interview with the licensee revealed all medications are locked and centrally stored. When R1 requested pain medication, the licensee prepared one nighttime dose in a plastic bag. S1 then assisted with the nighttime dose. S1 and the licensee stated they do not and have not left medications on nightstands or out in the open. Interviews with residents confirmed staff do not leave medication out. Based on interviews, staff properly handled R1’s medication. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff did not meet resident's hygiene needs” it was alleged staff did not assist with R1’s toileting needs. Interview with S1 revealed they changed R1 whenever necessary. The facility also ordered a urinal for R1 to use. S1 stated R1 had no bowel movements during their time at the facility.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20231020083303
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: PEARL OF WEST HILLS, INC
FACILITY NUMBER: 197609889
VISIT DATE: 04/03/2024
NARRATIVE
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Interviews with residents revealed they had no concerns about the facility’s incontinence care. Based on interviews, staff met R1’s hygiene needs. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety risks were observed during this visit.

Exit interview conducted. Appeal rights discussed. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3