197610087-6-11-2024-31-AS-NGID-D6TSQG-20240703140443

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610087
Report Date: 06/11/2024
Date Signed: 06/11/2024 03:35:46 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.RO, 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
06/06/2024 and conducted by Evaluator Perchui Khurshudyan

COMPLAINT CONTROL NUMBER: 31-AS-20240606110421

FACILITY NAME:	CON CARINO BRAEBURN		FACILITY NUMBER:	197610087
ADMINISTRATOR:	MORALES, LINDA		FACILITY TYPE:	740
ADDRESS:	1744 BRAEBURN RD		TELEPHONE:	(626) 485-7756
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	6	CENSUS: 6	DATE:	06/11/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Maryuri Yudith Cartin Sanchez-Staff		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff did not ensure the resident's call buttons were within reach of the resident.
Facility staff not available to meet the needs of the resident.
Facility staff do not ensure resident's hygeine needs were met.
Staff violated residents rights.

INVESTIGATION FINDINGS:

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At 10:00am, Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Angela Panushkina conducted an unannounced initial complaint visit at this facility to investigate the above allegations. Upon arrival, LPAs met with the Staff, who granted access to the facility. Administrator was contacted and LPAs explained the reason for the visit. Due to the Administrator being out of town a Designee/House Manager, Stacy Santana-Lopez, was called in.

During course of the investigation, interviews and record review were made. At 10:05am, LPAs requested resident and staff roster. At 10:10am, LPAs requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, relevant to the investigation. At approximately 10:15am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:20am – 12:30pm, LPAs interviewed the facility Manager, four (4) staff, three (3) out of six (6) residents, who were able to communicate and one (1) family member. Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

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-20240606110421

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CON CARINO BRAEBURN	FACILITY NUMBER: 197610087
	VISIT DATE: 06/11/2024

NARRATIVE

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Allegation: Facility staff did not ensure the resident's call buttons were within reach of the resident.

It was alleged that R1 had no call button within the reach and could not attain anyone’s attention for 1.5 hours. To investigate this allegation LPAs conducted an interview with the House Manager and were informed that the facility provides bells to all residents. However, Alzheimer's residents are not being provided with the bell, due to not being able to comprehend and or use it. Interview with four (4) staff members revealed that all residents are being checked every one to two hours. Moreover, the facility has an awake staff at night and all residents are being checked regularly, as scheduled. Lastly, two (2) out of six (6) residents interviewed expressed no concerns regarding this allegation. Therefore, based on the interviews and LPAs observation this allegation is deemed Unsubstantiated at this time.

Allegation: Facility staff not available to meet the needs of the resident.

It was alleged that R1 could not attain anyone’s attention for 1.5 hours, believed the overnight care staff S1 had fallen asleep. To investigate this allegation LPAs conducted an interview with the House Manager and S1 and concluded that facility has overnight awake staff, also every 1 to 2 hours the staff regularly check on all residents. In addition, LPAs interviewed two (2) out of six (6) residents and they stated staff always responds to their calls during the nighttime. Moreover, interview with a family member also revealed that all facility staff provide a great care and are available to assist residents upon request. Therefore, based on the interviews and LPAs observations this allegation is deemed unsubstantiated at this time.

Allegation: Facility staff do not ensure resident's hygiene needs were met.

It was alleged that R1 had long, unkempt nails and the staff did not ensure the hygiene needs were met. To investigate this allegation LPAs conducted an interview with the Administrator and a House Manager and were informed that R1 has very high standards and is always out from the facility. Although, the facility has a scheduled Podiatrist come to the facility every two (2) months, R1 stopped receiving his services due to other personal appointments. During the interview with five (5) residents, LPAs observed all residents manicure and pedicure is well taken care of. Lastly, interview with two (2) out of six (6) residents expressed no concerns regarding this allegation. Therefore, based on the interviews and LPAs observations this allegation is deemed unsubstantiated at this time.

Continue on LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20240606110421

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CON CARINO BRAEBURN	FACILITY NUMBER: 197610087
	VISIT DATE: 06/11/2024

NARRATIVE

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Allegation: Staff violated residents rights.

It was alleged, that R1 had a small purple bruise on the back of his/her right hand, about the size of a dime, which was also caused by S1. To investigate this allegation, LPAs reviewed R1s Centrally Stored Medication and Distraction Record (CSMDR) and observed that R1 is currently receiving a blood thinner that can cause bruising. Moreover, LPAs conducted interviews with the Administrator, House Manager and four (4) staff members and all parties interviewed denied ever abusing residents. In addition, two (2) out of six (6) residents interviewed expressed no concerns regarding this allegation and informed LPAs that they are very pleased with the staff's care provided. Lastly, interview with a family member also revealed that no resident was ever witnessed to be abused by the staff. Therefore, based on the interviews and file reviews, LPAs found this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

LIC9099 (FAS) - (06/04)

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