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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850019
Report Date: 08/06/2025
Date Signed: 08/06/2025 02:10:57 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
06/04/2025 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20250604165335
FACILITY NAME:LORIE'S RCFE LLC #2FACILITY NUMBER:
425850019
ADMINISTRATOR:VALADEZ, LORIEANNFACILITY TYPE:
740
ADDRESS:1100 GRAPEVINE RDTELEPHONE:
(805) 348-1155
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:6CENSUS: DATE:
08/06/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:TIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Medication was not given as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the above facility to issue final findings. LPA met with Administrator Freda Robles and Administrator Desingee Claire Aviado, explained the purpose of the visit.

During the initial visit on 6/5/25, LPA Rankin interviewed two administrators and obtained relevant documents. Additional interviews were conducted with relevant parties on 6/4/25, 6/6/25, 7/29/25, 7/30/25, and 8/4/25. LPA collected Resident 1’s (R1) hospice file, hospice handbook, text correspondence, pictures of R1, and additional records emailed from the facility.

On the allegation – Medication was not given as prescribed:

It was alleged that R1 was not provided with the medication Lasix as prescribed by their physician, resulting in swelling in their feet. R1 was admitted to the facility and hospice on 2/28/23. Continue on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
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 4
Control Number 29-AS-20250604165335
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LORIE'S RCFE LLC #2
FACILITY NUMBER: 425850019
VISIT DATE: 08/06/2025
NARRATIVE
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Upon review of R1’s facility file, documents show staff identified missing medication, two of which were Lasix and KCL (potassium). Both medications were listed on a physician’s verification form dated 1/23/23.

Hospice Records state the following:

Hospice charting visits on 3/1/23, 3/8/23, and 3/10/23 state: resident had edema, medications were reviewed, and caregivers demonstrated medication compliance. Additional notes from Hospice: 3/8/23: New note: “+1 edema noted to BLE (bilateral lower extremity)…3/10/23: New note: “3+ edema...and new fluid blisters noted to the top of (R1)’s feet.” 3/17/23: New note: “Pt encouraged to take (their) Lasix to assist with edema.” Hospice Medication list states Lasix and Potassium’s start date was 2/28/23.

The facility's Centrally Stored Medication and Destruction Record (CSMDR) shows that “Furosemide” (Lasix) was ordered, filled, and started on 3/9/23, and potassium was started on 3/10/23.

Correspondence confirms that an attempt was made by the administrators to get medication from hospice on 3/6/23. Both sets of messages confirm that the Lasix medication was received and given on 3/9/23. Correspondence received by LPA notes a conversation from the administrator, dated 3/9/23, which states the facility showed the Nurse Practitioner (NP) blisters on the top of R1’s foot. “It’s because of (R1)’s edema. Hopefully, when (R1) starts the Lasix, this will help (R1).”

Nurse Practitioner notes on a “Physician Visits” form, dated 3/9/23, “Pt very SOB (short of breath). Increase Furosemide to 80mg Q am,” indicating the medication could assist in this symptom.

When administrators were asked about the delay, they couldn't remember specifics due to the incident occurring over two years ago. Notes and messages indicated that the medication was discussed with the hospice nurse on 3/1/23 as missing. The administrator mentioned that the family brought part of the medication and was supposed to bring the rest. The administrator states they asked the nurse for the missing medication again on 3/6/23.

Continue on 9099-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20250604165335
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LORIE'S RCFE LLC #2
FACILITY NUMBER: 425850019
VISIT DATE: 08/06/2025
NARRATIVE
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In an interview on 8/4/25, Hospice Nurse believed the family would bring the missing medication and admitted that the facility reached out on 3/6/23. Nurse did not confirm the medication was still missing until the second visit on 3/8/23. Hospice notes show that a rush order for Lasix was requested on 3/9/23.

The hospice agency handbook provides that a pharmacist could assist with medication questions and there is a 24-hour hospice hotline, but no interviews or records show these resources were utilized.

Records and interviews concluded that R1’s Lasix and potassium were not administered from 3/1/23 to 3/8/23. While attempts were made to obtain medication through hospice and the family, it is the facility's responsibility to follow physicians’ orders, ensure scheduled medications are administered, and arrange care appropriate to the conditions and needs of residents.

Based on LPA’s observations, interviews conducted, and record reviews, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED.

Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC9099-D).

Exit interview conducted, appeal rights discussed, and a copy of this report issued.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20250604165335
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LORIE'S RCFE LLC #2
FACILITY NUMBER: 425850019
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/07/2025
Section Cited
CCR
87465(a)(1)
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87465 Incidental Medical and Dental Care (a)A plan for incidental medical...care shall be developed by each facility. The plan shall encourage routine medical…care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical…care appropriate to the conditions and needs of residents.
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Licensee agrees to create intake process for all residents, including hospice, to ensure that all medications are reconciled, and received to ensure medication orders are followed. Licensee will provide a statement to Licensing stating how they will handle missing medications going forward.
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This requirement is not met based on interviews and record reviews, licensee did not comply with the section cited above when facility failed to ensure medications were received or ordered upon intake of resident and admittance of hospice care plan, which posed an immediate health and safety risk to 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: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4