197609950-3-11-2023-31-AS-NMAN-CPZN9V-20230317101633

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609950
Report Date: 03/11/2023
Date Signed: 03/11/2023 11:13:56 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
08/25/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20220825154325

FACILITY NAME:	PRIME RESIDENTIAL SENIOR CARE		FACILITY NUMBER:	197609950
ADMINISTRATOR:	KHECHIKYAN, SOFYA		FACILITY TYPE:	740
ADDRESS:	19418 LANARK STREET		TELEPHONE:	(818) 626-8553
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 6	DATE:	03/11/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Sofya Khechikyan		TIME COMPLETED:	11:18 AM

ALLEGATION(S):

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Resident was overmedicated while in care.
Due to staff neglect resident developed multiple Urinary Tract Infections.
Resident was placed on hospice while at the facility without consent of resident's representative.
Staff did not seek medical attention for resident in care in a timely manner.
Staff did not ensure that resident in care received follow-up medical attention.

INVESTIGATION FINDINGS:

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At 11:00 a.m. on 03/11/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with the Administrator and disclosed the reason for the visit.

Initial investigation visit was conducted by the LPA Wendell Smith on 08/26/2022. At the time of visit between 9:30am and 11:00am, LPA Smith conducted a physical plant tour and interviewed the administrator. The case was later referred to the Investigation’s Branch (IB) and an investigation was continued by the IB Investigator Seng. LPA Reed reviewed Investigator Seng’s report at 5:00 p.m. on 01/03/2023 and at 9:50 a.m. on 01/13/2023.

Regarding the allegation “Resident was overmedicated while in care”, it was alleged Resident #1 (R1) was overmedicated with antipsychotic medication. At the time of investigation, R1 was no longer at the facility. R1 moved to another location on 09/19/2022.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2023

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-20220825154325

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: PRIME RESIDENTIAL SENIOR CARE	FACILITY NUMBER: 197609950
	VISIT DATE: 03/11/2023

NARRATIVE

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During investigation, between 09/20/22 and 11/29/22 IB investigator Seng conducted interviews with R1’s hospice and palliative care physician, facility Administrator, other staff, residents, witnesses, and a family member. The facility staff indicated that they assisted R1 with all prescribed medications, which included medications prescribed by the Hospice doctor. R1’s family member was unaware that since R1’s admission to hospice care on 07/07/2022, R1 was prescribed with additional medications. As per hospice physician, the medications prescribed to R1 were ineffective and therefore could not have been used as chemical restraints. A review of R1’s medication record conducted by LPA Reed on 01/13/2023 at 9:50am, revealed that in addition to R1’s medication prescribed by R1’s regular physician, resident was receiving other medication prescribed by the hospice doctor. The information revealed from record review verified the information received from staff interviews. Based on interviews and record review, there is not sufficient information to support the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Due to staff neglect resident developed multiple Urinary Tract Infections”, it was alleged R1’s multiple UTIs were caused by overmedication and staff removing R1’s catheter. From interviews of medical professionals, facility staff, and residents and review of medical records conducted by IB Investigator Seng between 09/20/22 and 11/29/22, R1’s medications would not have caused a UTI or constipation. R1’s UTIs and constipation were likely the result of dehydration, and the irritation of a UTI was a probable cause for R1 removing their catheter. Staff noted multiple attempts to keep R1 hydrated. R1 admitted to removing their catheter several times from July 2022 to September 2022 due to discomfort. Based on interviews and record review, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Resident was placed on hospice while at the facility without consent of resident's representative”, it was alleged R1 was placed under hospice care without consent from their responsible person. From ~~record~~ review of facility files conducted on 01/13/2023 at 9:50 a.m., R1 was admitted to the facility with no responsible person. R1’s medical assessment showed no legal representative either. R1’s admission was contracted through the Department of Mental Health. R1 signed their own hospice paperwork on 07/07/2022. From IB Investigator Seng’s interview of the facility Administrator on 09/20/2022, the facility did not receive any paperwork identifying family member as a designated Power of Attorney (POA) for R1. The information revealed from R1’s records verified the information received from the Administrator. Based on record review and interviews, the allegation is deemed UNSUBSTANTIATED at this time.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2023

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220825154325

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: PRIME RESIDENTIAL SENIOR CARE	FACILITY NUMBER: 197609950
	VISIT DATE: 03/11/2023

NARRATIVE

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Regarding the allegation “Staff did not seek medical attention for resident in care in a timely manner”, it was alleged the facility did not immediately attend to R1’s medical needs. From record review conducted on 01/13/2023 at 9:50 a.m. R1 was hospitalized three times while at the facility. Staff Interviews conducted by IB Investigator Seng on 09/20/2022 revealed that R1 was in poor health upon arrival, but staff did their best to care for R1. While in care, R1 was hospitalized few times. In each instance, the facility notified R1’s case workers, hospice agency, primary care physician, and Community Care Licensing. 9-1-1 was called immediately thereafter. Based on interviews and record review, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff did not ensure that resident in care received follow-up medical attention”, it was alleged R1’s overmedication led to their bowel blockage and staff did not provide required medical attention. From staff interviews conducted on 09/20/2022 by IB Investigator Seng, the hospice care was recommended for R1 due to their chronic pain and constipation. In addition, staff attempted to hydrate R1 on an hourly basis. From record review conducted on 01/13/2023 at 9:50 a.m. by LPA Reed, R1 had a history of chronic constipation. The facility’s sign-in sheet showed multiple visits each month from case managers and hospice nurses visiting R1 to address chronic health problems. Based on interviews and record review, the is an insufficient information and evidence to support the allegation, Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety issues were noted during this visit.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2023

LIC9099 (FAS) - (06/04)

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