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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610305
Report Date: 12/13/2022
Date Signed: 12/13/2022 01:03:45 PM

Substantiated


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
12/07/2022 and conducted by Evaluator Patrick Shanahan
COMPLAINT CONTROL NUMBER: 31-AS-20221207151234
FACILITY NAME:BRIGHTSTAR SENIOR CARE,INCFACILITY NUMBER:
197610305
ADMINISTRATOR:ALLAHDADI, AYEDEHFACILITY TYPE:
740
ADDRESS:10455 GAYNOR AVETELEPHONE:
(818) 517-0544
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 2DATE:
12/13/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Narineh Ohanian/ StaffTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Resident’s are locked inside of facility.

Facility outdoor passageway is not kept free of obstruction.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in response to the above mentioned allegations. The LPA was greeted by facility staff and all Covid checks were preformed before allowing the LPA entrance. The administrator was notified of the LPA's visit and arrived a short while later.

Allegation 1. Resident’s are locked inside of facility.
The LPA was able to interview staff and residents regarding this allegation. Facility staff denied ever locking or restricting the residents movements while inside the facility. There were two residents residing at the home during the visit. The first resident (R1) was interviewed at the kitchen table and could not recall if the doors had been locked. R1 appeared to be forgetful and at times confused. The second resident (R2) was interviewed in R2's room. R2 stated that R2 had never tried to leave the facility unassisted and required a walker to move around.
Continues on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
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 3
Control Number 31-AS-20221207151234
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: BRIGHTSTAR SENIOR CARE,INC
FACILITY NUMBER: 197610305
VISIT DATE: 12/13/2022
NARRATIVE
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A credible witness toured the home in November of 2022 and observed a staff member pull a pin out of a drilled hole on the facility front door frame, which allowed the door to remain closed even if the door was unlocked. During an inspection of the home, the LPA did observe the hole in the door frame and the front door. The LPA also observed that the back sliding door also had locks at the bottom of the sliding glass door that could prevent the doors from opening. Based on the LPA observations of the drilled holes in the front door, the locks on the back sliding door and the confirmation from the credible witness, this allegation is deemed SUBSTANTIATED at this time.

Allegation 2. Facility outdoor passageway is not kept free of obstruction.
LPA was able to tour the facility in order to investigate this allegation. While touring R1's room, the LPA observed a chair, clothing, shoes and other personal effects blocking the sliding glass door and preventing the the passageway to be free of obstruction. The facility staff reminded the resident not to block the passageway and staff assisted the resident in moving the personal items into the closet. Based on staff and LPA observation, this allegation is deemed SUBSTANTIATED at this time.

Exit Interview conducted, deficiencies cited and appeal rights discussed.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20221207151234
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: BRIGHTSTAR SENIOR CARE,INC
FACILITY NUMBER: 197610305
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/14/2022
Section Cited
CCR
87468(a)(5)
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87468.1 Personal Rights of Residents in all Facilities-(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (5) To leave or depart the facility at any time and not be locked in any room, building, or facility premises by day or night...
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The administrator agrees to remove the locks on the sliding back doors and fix the holes in the front door. The administrator will then submit photos of the repair and a statement noting that she has read and understands this regulation.
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This requirement was not met as evidenced by:LPA observation of holes drilled in the front door to lock it and locks installed on the sliding door, which poses an immidiate risk to the health and safety of residents in care
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Type A
12/14/2022
Section Cited
CCR
80087(c)
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80087(c) Buildings and Grounds. Outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction. This requirement is not met as evidenced by; Based on inspection and observation, Licensee did not keep the
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The administrator agrees to clear the obstruction from in front of the door, submit photos and put into writing her understanding of this regulation.
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R1's passageway free from obstruction, which poses an immediate risk to the health and safety of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC9099 (FAS) - (06/04)
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