197610305-3-14-2023-31-AS-EMIR-CQVML6-20230414094147

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610305
Report Date: 03/14/2023
Date Signed: 03/14/2023 01:46:24 PM

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
03/07/2023 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20230307095829

FACILITY NAME:	BRIGHTSTAR SENIOR CARE,INC		FACILITY NUMBER:	197610305
ADMINISTRATOR:	ALLAHDADI, AYEDEH		FACILITY TYPE:	740
ADDRESS:	10455 GAYNOR AVE		TELEPHONE:	(818) 517-0544
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 4	DATE:	03/14/2023
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Ayedeh Allahdadi, Narineh Ohanian		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff does not provide resident medications as prescribed.
Staff did not provide resident with resident's medical records as requested.
Staff did not accord resident privacy.
Staff withheld resident' personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Mariana Agban and Michael Cava conducted a complaint visit at the facility to investigate the above allegations. LPAs met with the administrator, Ayedah Allahdadi and staff, Narineh Ohanian, and advised them of the complaint. Today's investigation consisted of interviews with residents and staff that were held between 8:40am to 11:00am. At approximately 11:00am to 12:00pm, a physical plant inspection was made. Between 12:00pm and 1:00 pm, LPAs conducted a record revew.

Staff does not provide resident medications as prescribed:
In regards to the allegation, it was reported that Resident 1 (R1) was not given their medication consistently. Interview made with R1 could not confirm the allegation. R1 could not identify what medication and what time of the day, their medications were supposed to be taken. Interviews with the administrator and staff indicate that R1 received their medication as prescribed. LPAs also interviewed two of two residents. Both residents reveal that they've received their medications as prescribed by their doctor. Based on

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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 31-AS-20230307095829

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: 03/14/2023

NARRATIVE

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the information obtained, there was insufficient evidence to corroborate the allegation of staff not providing R1 with their medication as prescribed. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff did not provide resident with resident's medical records as requested/Staff withheld resident' personal belongings:
In regards to the above allegations, it was reported that upon leaving the facility, R1 wasn't given their facility and medical records. It was also alleged that R1's personal belongings (checkbook, check card, wallet) were withheld upon departure. Interview made with R1 reveal that R1 may have lost some of their personal items when moving out of the facility. Interviews made with administrator and staff reveal that R1's personal belongings, medical records, and facility records were given to R1 upon leaving the facility. The administrator provided written documentation, with R1's signature, acknowledging that they have received their personal belongings when departing the facility on 10/31/22. Furthermore, on a previous complaint (see control #31-AS-20221020145038), there was also confirmation that facility provided R1 with their Admission Agreement per R1's request. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff withholding R1's medical records and personal belongings. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff did not accord resident privacy:
In regards to the allegation, it was reported that R1's incoming telephone calls and visitation are screened, allowing no privacy. Interview with R1 reveal that they have no close family and friends to visit them. R1 did state staff would sit near them when making phone calls. No witnesses, date and time provided by R1 to corroborate the allegation. LPAs interviewed two of two residents, who both indicated they are allowed to make and receive phone calls in private. Both residents also acknowledge they receive visitation rights with privacy. Based on the information obtained, there was insufficient evidence to prove staff do not provide residents with privacy. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

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