197610004-2-21-2023-29-AS-JAPL-CQDRUA-20230329131935

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610004
Report Date: 02/21/2023
Date Signed: 02/21/2023 04:11:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/11/2021 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20211011135312

FACILITY NAME:	VALLEY VIEW ASSISTED LIVING		FACILITY NUMBER:	197610004
ADMINISTRATOR:	GASPARYAN, SUSANNA		FACILITY TYPE:	740
ADDRESS:	20565 CALIFA STREET		TELEPHONE:	(747) 226-1408
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	6	CENSUS: 6	DATE:	02/21/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Susanna Gasparyan, Administrator		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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1. Resident is left soiled while in care
2. Resident is not receiving medication as prescribed
3. Staff are not providing appropriate care and supervision to a resident while in care
4. Staff do not have planned activities for a resident
5. Resident is not being properly fed while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced subsequent complaint visit to continue the investigation into the allegations noted above and to deliver the findings. LPA Yee met with Susanna Gasparyan, Administrator and the reason for today's visit was explained.

An initial complaint vist was conducted on 10/19/2021 by LPA Teresa Camara. During the intial visit, LPA conducted a brief physical plant tour at 10:20 a.m., interviewed Administrator at 10:38 a.m., interviewed a witness at 11:45 a.m. and reviewed records at 11:15 a.m.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

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 29-AS-20211011135312

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VIEW ASSISTED LIVING	FACILITY NUMBER: 197610004
	VISIT DATE: 02/21/2023

NARRATIVE

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On today's visit, LPA Yee conducted additional interviews with the Administrator at 11:14am , interviewed Staff #1 at 1:13pm and reviewed facility files beginning at 11:58am - 12:43pm. Resident #1, who lived a very short time at the home could not be interviewed since the resident had been relocated to another home and then to a skilled nursing facility. The relocation site is unknown

Per the investigation, the following is the information received for each allegation:

Allegation #1: Resident is left soiled while in care - Per interviews conducted with the Administrator, staff and witnesses - Resident #1 was never left in soiled diaper. Residents are checked every 2 hours and they are also able to let the staff know when changing is needed. Residents are also asked if they want to bathe daily and encouraged to bathe a minimum of 1 to 2 times a week. During the short stay at the home, Witness #1, who provided health services to Resident #1 was interviewed and there no concerns expressed or any neglect was observed with the resident's care

Allegation #2: Resident is not receiving medication as prescribed. Per review of the facility files, Resident #1 was given medications that came with the resident at the time of discharge from skilled nursing and documented on a Medication Administration Record. Medications that were added after admissions - Plavix and Pentroprazole were also documented as dispensed. Pain medication was not listed on the discharge paperwork. Since Resident #1 no longer resides at the home, it is unknown which medication(s) were not dispensed as prescribed. Per Witness #1, the medication list looked correct.

Allegation #3: Staff are not providing appropriate care and supervision to a resident while in care. The facility has a Hoyer lift to transfer the resident to a wheelchair if Resident #1 wanted to get up. Resident #1 was helped getting to the bathroom and into the wheelchair when asked. Staff did not ignore the resident. Resident #1 preferred to remain in bed.

Continue of LIC9099-C

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20211011135312

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VIEW ASSISTED LIVING	FACILITY NUMBER: 197610004
	VISIT DATE: 02/21/2023

NARRATIVE

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Allegation #4: Staff do not have planned activities for a resident - per interviews conducted with the Administrator, the facility has board games, residents like to play dominoes, card games, listen to music, exercise, celebrate birthdays and holiday, have discussions or watch television. One resident likes to crochet and the facility purchases yarns for the resident. The residents decide what they want to do or not to do.

Allegation #5: Resident is not being properly fed while in care - Per interview with the Administrator and Staff #1, the residents are provided with 3 meals and 3 snacks a day. The facility makes plenty of food for second helpings. Staff ask residents what they want to eat and they will cook their favorite foods. Lunch was observed on today's visit and pizza was served at the residents' request. Based on the information received from interviews, Resident #1 would over eat and would feel miserable and would stick a finger in the throat to throw up. Resident would want food at all times of the day and night and it was provided when it was requested. Per staff, they never denied Resident #1 or any resident food.

Based on the investigation, it was determined that all the above allegations were unsubstantiated.

Exit interview was conducted with Susanna Gasparyan and a copy of this report was provided.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

LIC9099 (FAS) - (06/04)

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