California · Canoga Park

Canyon Trails at Topanga Senior Living.

RCFE120 bedsDementia-trained staff(818) 716-9900
Facility · Canoga Park
A 120-bed RCFE with 7 citations on file.
Licensed beds
120
Last inspection
Dec 2025
Last citation
Aug 2025
Operated by
Canoga Park Sh Llc; Integral Senior Living Mgt
Snapshot

A large home, reviewed on public record.

Canyon Trails at Topanga Senior Living

© Google Street View

Approximate location
Peer Comparison

Compared to 123 California facilities with a similar number of beds.

RCFE · 36-month window. Higher percentile = better performance on inspection record. Source: California Dept. of Social Services · Community Care Licensing.

Severity rank
42nd%
Weighted citations per bed.
peer median
0
100
Repeat rank
Not enough repeat citations
among peers to rank.
Repeat deficiencies as share of total.
Frequency rank
22nd%
Deficiencies per inspection.
peer median
0
100

Rankings based on 36-month CDSS inspection data. Severity and frequency: fewer citations = higher percentile. Repeat rate: lower repeat citation share = higher percentile.

FACILITY WATCH · FREE

Canyon Trails at Topanga Senior Living has 7 citations on record. Know the moment anything changes.

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The Rulebook

The rules that apply to this facility.

State requirements with the exact regulation citation, plain-language explanation, and a question to ask on tour. Rules this facility has been cited for appear first.

What dementia-care training must staff complete?22 CCR §87705 / HSC §1569.625
Cited Feb 2025+
Plain language

Because a facility markets dementia or Alzheimer's care, state law mandates higher training standards: 12 hours of initial dementia training (6 hours before a staff member works independently with residents, 6 more within the first 4 weeks), 8 hours of annual dementia in-service every year thereafter, and an administrator must include 8 hours of dementia-specific continuing education in every 2-year recertification cycle. Training must cover individualized care plans, behavioral expressions, appropriate supervision, and the facility's dementia care philosophy.

Ask on tour

Can you show me each direct-care staffer's most recent dementia training certificate, and tell me when their next refresher is due?

Tour Prep

Questions to ask before you visit.

A short pre-tour checklist tailored to Canyon Trails at Topanga Senior Living's record and state requirements.

01 /

The facility holds 120 licensed beds and is operated by Canoga Park Sh Llc under Integral Senior Living Mgt — can you provide the current CDSS license certificate showing the active status and expiration date?

Ask the operator on tour. Take notes and compare answers across facilities you visit.

02 /

CDSS records show zero deficiencies and zero complaints on file for license 197608998 — can you walk families through your most recent state inspection report and explain your compliance monitoring process?

Ask the operator on tour. Take notes and compare answers across facilities you visit.

03 /

The facility advertises memory care services but does not hold a formal memory-care designation in CDSS licensing records — what dementia-specific programming and staff training do you provide, and is it documented in a written care plan?

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Full Inspection Record

Every inspection visit, verbatim.

15 inspections in the public record, most recent first. Click any row to expand — cited rows open automatically.

15
reports on file
7
total deficiencies
2025-12-23
Other Visit
No findings
Inspector · Perchui Khurshudyan

Plain-language summary

An investigator visited the facility to review resident and staff rosters and inspect the physical plant, and also investigated four complaints: that hallways smelled of urine and feces, that food quality was poor, that residents' personal belongings were not safeguarded, and that staff restricted a resident's access to grooming items. The investigator toured hallways, common areas, and resident rooms; interviewed nine residents, directors, and six staff members; observed a meal service; and checked resident rooms and laundry practices. All four allegations were found to be unsubstantiated—the investigator did not observe foul odors, observed appropriate meal preparation and resident satisfaction with food, found no evidence that staff failed to safeguard belongings, and the investigation of the fourth allegation was incomplete in the provided text.

Read raw inspector notes

During today’s visit, LPAs requested resident /staff rosters, and 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. No health and safety hazards were noted during the visit. Allegation: Staff do not ensure the facility is free of foul odors. It was alleged that the facility hallway smells of urine and feces. To investigate the allegation, LPA toured the Assisted Living (AL) and Memory Care (MC) hallways, common areas, and residents’ rooms. During the tour LPA did not observe strong or persistent odors of urine/feces. Interviews were conducted with nine (9) residents residing in the MC and AL, the Executive Director, Memory Care Director, and six (6) Staff/Caregivers. The majority of residents described the facility as generally clean and odor free. Residents who were able to communicate stated that the housekeepers do daily light cleaning and weekly deep cleaning to their rooms. LPA checked random residents’ rooms and observed trash bins to be empty, and no soiled diapers were present inside residents’ rooms. Interviews with staff members stated that occasional short-lived odors may happen and described procedures for promptly cleaning incontinence related incidents happening in common areas and removing soiled linens and trash. All interviewees denied ongoing odor concerns and confirmed that hallways and common areas are cleaned and sprayed daily. Based on observations and interviews, the allegation that staff do not ensure the facility is free of foul odors is Unsubstantiated. Allegation: Staff do not ensure the food being served is of good quality. It was alleged that the Staff do not ensure the food being served is of good quality. To investigate the allegation, LPA interviewed nine (9) residents residing in the MC and AL, the Executive Director, Memory Care Director, the Chef and six (6) Staff/Caregivers. LPA observed the meal service and reviewed the facility’s description of menu planning and substitutions. Residents interviewed regarding meal quality, variety, and whether they were regularly served poor quality food. Residents confirmed that meals are acceptable and varied. Residents also stated that there is always alternative food for each mealtime and added that variety of sandwiches are always available as a substitute for the main meal. Interviews with staff members stated sandwiches are served at times as part of meal options when residents refuse the main meal. Continue on LIC9099-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Interview with the Chef and review of weekly meal menu also confirmed that facility provides variety of good quality and nutritious food to all residents in care and they always have alternative food including deli sandwiches. Chef also added that the facility menu is being prepared, verified, and confirmed by the chef and the nutritionist. During the visit, the LPA observed residents being served lunch and did not notice any concerns regarding food quality. The meal provided appeared appropriate and well-prepared, and the LPA did not observe residents being served only sandwiches or any indication of poor-quality food. Based on observations and interviews, the allegation that staff do not ensure food served is of good quality is Unsubstantiated. Allegation: Staff do not ensure resident's personal belongings are safeguarded. It was alleged that staff do not ensure residents’ personal belongings are properly safeguarded. To investigate this concern, the LPA interviewed nine residents from the Memory Care (MC) and Assisted Living (AL) units, as well as the Executive Director, Memory Care Director, and six staff members, including laundry staff. Laundry staff explained their process for collecting, sorting, washing, drying, and returning clothing, noting that each resident follows an individual laundry schedule and that all loads are washed separately. They also stated that residents’ clothing is labeled with their names to prevent items from being misplaced. Residents interviewed reported that they have not experienced missing clothing after laundry service. Some residents mentioned that clean clothes are occasionally returned in bags, but staff later organize them in the closets. During room checks, the LPA observed only unwashed clothing in laundry baskets and did not find clean clothing stored in bags. Staff further explained that some Memory Care residents place their own clothes into bags because they believe they are preparing to leave the facility. All staff denied leaving clean clothing in bags for a long period of time after washing and stated that residents sometimes misplace their own items in different drawers or forget where they placed them. Staff also noted that residents, mainly residing in Assisted Living, occasionally give clothing to one another and later report the items missing. Interview with the Executive Director revealed that the facility conducted an internal investigation regarding a missing ring. Staff were interviewed and relevant areas were checked; however, no witness reported seeing or hearing anyone take the ring. The investigation did not reveal any suspicious behavior or evidence indicating how or when the ring went missing. Based on the observation and information gathered, the LPA did not obtain evidence that staff failed to safeguard residents’ belongings or that facility practices resulted in lost personal property. Therefore, the allegation is Unsubstantiated. Continue on LIC9099-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation: Staff restricted resident’s access to resident’s personal grooming items without authorization . It was alleged that staff restricted a resident’s access to personal grooming items without authorization. To investigate this concern, the LPA interviewed nine residents from the Memory Care (MC) and Assisted Living (AL) units, as well as the Executive Director, Memory Care Director, and six staff members. Staff explained that certain toiletry items may be secured based on individual resident needs—such as cognitive impairment or required supervision—and that items are provided during ADL care to ensure residents receive appropriate oral hygiene and grooming support. Staff also noted that all bathroom cabinets in the MC unit are kept locked to protect residents’ health and safety, as some residents may wander into others’ rooms. Residents interviewed reported that staff assist them with hygiene and always provide necessary items. During room checks in the MC unit, the LPA observed that bathroom cabinets were locked, and no hygiene or potentially unsafe items were accessible without supervision. Based on these observations and interviews, the LPA determined that the facility safeguards residents’ health and safety by securing bathroom cabinets in the Memory Care unit; therefore, the allegation is Unsubstantiated. No Deficiency cited during today's visit. Exit interview conducted and a copy of this report signed and delivered.

2025-10-31
Annual Compliance Visit
No findings

Plain-language summary

A resident in the memory care unit managed to remove a sliding door lock and escape from a second-floor balcony using bed sheets on October 25, 2025, landing on a first-floor balcony; the resident was taken to the hospital and evaluated with no fractures or injuries found. The facility followed proper safety protocols and the inspector confirmed that all rooms have hatch locks limiting doors to six inches, and found no violations. After the incident, the facility installed additional hatch locks and security alarms on all sliding doors.

Read raw inspector notes

Licensing Program Analyst (LPA) Perchui Milena Khurshudyan, conducted unannounced Case Management visit - Incident to this facility and met with Peter Bonilla - Executive Director (ED) and Liliana Solorzano - Resident Care Director (RCD). LPA disclosed the reason for the visit. Today’s case management visit is to follow up on special incident report (SIR) reported to Community Care Licensing (CCL) on 10/25/2025 and to obtain additional information regarding the incident. On October 25, 2025, Community Care Licensing (CCL) received a Special Incident Report (SIR) from Memory Care Program Director – Diane Parras, reporting that Resident #1 (R1) residing in room # 223 in Memory Care Unit, attempted to escape from the facility. Interview with the ED and RCD revealed that R1 transferred to Memory Care unit two (2) days prior to the incident and did not show any signs of aggression or unusual behavior. Interview with R1’s roommate Resident #2 (R2) revealed that the day of the incident R1 was standing up at the sliding door starring outside and was walking inside the room not allowing R2 to sleep. R2 heard the sliding door open, however, fell asleep and couldn’t recall anything else after that. Additionally, interviews with staff revealed that approximately 2:20 am Staff 1 (S1) conducted routine checkup to R1s room and observed that R1 was still awake. Interviews also revealed that S1 came back again at around 2:35am and discovered that R1 managed to take off the installed hatch lock from the sliding door and had bed sheets tied on the balcony and climbed down to first floor landing in room # 121 balcony. 911 was immediately initiated and R1 got transferred to Northridge Hospital where R1 got evaluated and no fractures and / or injuries were found. After evaluation, R1 transferred to Kaiser Woodland Hills for further care and was admitted with diagnosis of paranoia. Continue on LIC809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA conducted physical plant tour, checked six (6) random residents’ rooms and observed all residents’ rooms have balconies and sliding doors. Additionally, LPA observed and confirmed that all rooms have hatch locked installed on each sliding door which does not allow the doors to open beyond six (6) inches. After the incident, the management installed additional hatch locks and security alarm signals on the upper part of all sliding doors to protect residents’ safety and prevent incidents in the future. Lastly, during today’s visit, LPA requested the maintenance staff to remove one of the hatches and observed that it is not possible even for maintenance staff to remove the hatch lock without proper tools. The removal process took about 5 minutes. The facility followed all the appropriate protocols to prevent R1's elopement; and therefore, no deficiencies will be issued during today’s visit. Exit interview conducted, copy of the report delivered.

2025-09-18
Other Visit
No findings

Plain-language summary

An annual inspection was conducted on September 18, 2025, and no violations were found. The facility, which houses 96 residents across memory care and assisted living units, was found to have clean and functional common areas, properly stocked kitchens, working safety equipment, secure medication storage, and staff responding to resident call signals within 1-2 minutes.

Read raw inspector notes

On 9/18/2025, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA introduced herself at the front desk by showing her department badge, was greeted by the Executive Director (ED) Bonilla Peter and the Assisted Living Director (ALD) Liliana Solorzano. LPA explained the reason for the visit and requested staff and residents’ rosters for review. LPA Khurshudyan reviewed the required postings on a wall and used the inspection tool to complete today's visit. A tour of the physical plant was conducted at around 10:00am and the following was noted: The facility is fire cleared for one hundred twenty (120) Ambulatory residents, of which one hundred (100) may be Non-Ambulatory, and twenty (20) may be Bedridden. The facility also has a hospice waiver for twenty (20) residents. The facility is currently occupying ninety-six (96) residents. There is one main entrance being utilized at the facility. The facility is two-story building and has two (2) elevators, one for each wing: Memory Care unit and Assisted Living, LPA checked both elevators operate properly. The facility has a total of ninety (90) rooms. Assisted living with private rooms for all residents, and Memory Care Unit with private and/or shared rooms. Continue on LIC809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA observed four (4) common bathrooms throughout the facility, all four bathrooms appeared clean and were functional. Bathrooms had signs, grab bars and paper towels. The kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days of non-perishable food. LPA observed a walk-in refrigerator and freezer stocked with adequate amount of frozen and fresh foods wrapped and stored appropriately. Food storage and preparation areas were clean and inaccessible to pests. Knives and sharps are observed to be locked, under supervision, and inaccessible to residents. A dietitian visits the facility every month. The daily menus were posted and available in the dining area. A restricted diet menu was also available for residents requiring special diets. The kitchen closes at 7:00pm and reopens at 5:30am. The common areas and dining room appeared neat and clean. The activity room and TV room were nicely furnished. The monthly activity schedule was posted and available for residents. The facility maintains a comfortable temperature at 73°F-75°F. The smoke and carbon monoxide detectors are hardwired, interconnected and centralized with automatic dispatch to the Los Angeles Fire Department. Last fire inspection was done on 2/24/2025. Fire extinguishers were located throughout the facility and observed to be fully charged and last inspected on 9/6/2024. LPA was informed that service date is already scheduled for next week and the service materials will be provided to LPA right away. LPA observed at least thirteen (13) fire extinguishers throughout the facility. LPA toured a random selection of resident rooms. All bedrooms were properly furnished and had appropriate bedding, linens and a lighting system. The call signal system was tested and functioned properly. Caregivers responded to call signals withing 1-2 minutes. Hallways were odorless and free of obstructions. Residents have enough personal hygiene products. The bathrooms were checked for cleanliness and proper operations. Towels and washcloths are not shared. There was enough clean linen available in each resident room. Hot water temperature measured between 114.3 and 117.2 degrees Fahrenheit. There is a separate Medication Room for Assisted Living and for Memory Care Unit. LPA observed properly labeled medications and residents’ medical files to be locked and inaccessible to residents in care. The facility maintains a complete first aid kit. The facility has three (3) laundry rooms located in the Assisted Living unit. The Laundry rooms observed to be locked. There is a resident laundry room on the second floor of the Assisted Living unit. Cleaning supplies, chemicals and detergents are stored inside the locked closets and inaccessible to residents. The facility has nice outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. All pathways are clear of obstruction. Continue on LIC-809C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Between 11:35pm -1:55pm LPA conducted records review of ten (10) staff files and ten (10) residents’ records. Files were complete and updated. LPA collected LIC500, LIC9020. No health and safety hazards noted during today’s visit. No citations issued during today's visit. Exit interview conducted. Copy of this report provided.

2025-08-27
Complaint Investigation
Substantiated
Type B · 2 findings
Inspector · Leslie Ngo-Castaneda

Plain-language summary

A complaint investigation found that one resident became aggressive and verbally abusive toward another resident on multiple occasions, including yelling racial slurs; staff were aware of the resident's behavioral changes but had not completed a formal reassessment of the resident's needs or behavior plan. An incident on March 8, 2025 resulted in police being called after mutual physical contact occurred between the two residents. During the inspection on March 12, 2025, the investigator witnessed similar aggressive behavior and observed that no staff were positioned nearby to intervene.

Type B22 CCR §87463(c)(3)
Verbatim citation text · 22 CCR §87463(c)(3)

expression based on the individual needs of the resident

Type B22 CCR §87468.1(a)(2)
Verbatim citation text · 22 CCR §87468.1(a)(2)

comply with the section cited above where R1 is aggressive towards R2, which poses a potential Health, Safety, or Personal Rights risk to residents in care.

Read raw inspector notes

LPA interviewed twelve (12) out of ninety-four (94) residents who are available and seven (7) staff who were available at the facility. LPA obtained the following documents: physician report, admission records, LIC 601, resident roster, employee roster, and other relevant documents to the investigation at 2:30 PM. LPA interviewed R2 on 3/12/2025, the interview revealed that R1 would throw a cup of water, be aggressive, and yell racial slurs at R2. An interview with staff revealed that R2 is very friendly and sociable to everyone at the facility, and no other residents in the facility have any issues with R2. On 3/8/2025, 9-1-1 was called, and police arrived. Officers determined there was mutual battery with no arrest. During LPA interview with R1 on 3/12/2025 at 3:16 PM at the dining hall, LPA witnessed R2 tap R1 on the shoulder and greet R1. R1 got very upset, and yelled racial slurs and insults towards R2, calling R2 “monkey”. LPA witnessed no staff within reach to redirect R1 and R2. An interview with the executive director (S1), assisted living director (S2), and five (5) staff members revealed that R1 has been aggressive and angry towards R2 previously early this year. Record review for R1 revealed that R1 has been residing at the facility since 5/26/2021, and R2 has been residing at the facility since 1/10/2022. Staff are aware of the behavioral changes with R1, and the record review revealed that no resident re-appraisal was done. Based on interviews, observations, and record review, there is enough information to verify the allegation. Therefore, the allegation is SUBSTANTIATED at this time.

2025-05-28
Complaint Investigation
Unsubstantiated
No findings
Inspector · Perchui Khurshudyan

Plain-language summary

A complaint alleged that one of the facility's two elevators had been broken for at least four months. During the inspection on March 27, 2025, inspectors found that one elevator was indeed not working, but confirmed that the facility had ordered parts in February, started repairs on March 5, and had both elevators fully operational by the time of the visit; residents and visitors were using the working elevator in the meantime. The allegation was found to be unsubstantiated because the facility took prompt action to repair the equipment and had no violations.

Read raw inspector notes

Allegation: Facility elevator is in disrepair. It was alleged that one of the facility elevators is in disrepair and has been out of service for at least four (4) months. During the physical plant tour, conducted on 03/27/25, LPA observed one (1) out of two (2) elevators was not operational. The interview with the Building Service Director revealed that the facility received new elevator parts in February of 2025 and the installation process started on 3/5/2025. LPA was also informed that the elevator will be fixed and fully operational by 04/01/2025. Moreover, the Building Service Director informed LPA that all non-ambulatory residents, visitors and family members are currently using the second elevator around the facility and those that are capable use the stairs, the staff members are impatient to finalize the process to have both staff and residents’ transfers with less complications. Lastly, during today’s visit LPAs used both elevators and observed that two (2) out of two (2) elevators are currently in good repair and operational. Based on LPAs inspection, observation, records review, and interviews, there is enough evidence to verify that the Executive Director of the facility and the Corporate took proper actions to handle the situation to repair the elevator. Additionally, all documents confirmed the receipts and the new parts invoices of the second elevator. Therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and signed report delivered.

2025-05-07
Annual Compliance Visit
No findings

Plain-language summary

On May 7, 2025, an unannounced inspection was conducted to verify that two residents recently relocated from another facility were properly admitted and documented. The inspector reviewed admission records and confirmed both residents were appropriately registered at the facility. No violations were found.

Read raw inspector notes

On 5/7/2025 at 2:00pm, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an unannounced Case Management-Other visit to the above facility. LPA met with the Executive Director Peter Bonilla and explained the reason for the visit. LPA was informed that Resident #1 (R1) and Resident #2 (R2) who have been relocated from Santa Clarita Hills Senior living are currently residing in the above facility. At 2:20pm LPA requested LIC9020 and reviewed which confirmed that R1 and R2 are residing the above-mentioned facility. No deficiencies issued during today’s visit. Exit interview conducted and copy of this report signed and delivered.

2025-02-27
Other Visit
Type B · 1 finding
Inspector · Perchui Khurshudyan

Plain-language summary

On February 27, 2025, regulators conducted a follow-up inspection to investigate a complaint about two incidents in November 2024 involving a resident with wandering behavior who attempted to leave the memory care unit. During the first incident on November 3, the resident became aggressive while staff tried to redirect them, fell and hit their face on a door; during the second incident on November 4, the resident was able to exit through a back door and fell on concrete, requiring hospitalization. The facility was cited for failing to respond quickly enough to the door alarm and not having adequate night shift staff on the floor to prevent these incidents, with two staff members assigned to cover both the first and second floors for 55 residents.

Type B22 CCR §87705(e)(7)
Verbatim citation text · 22 CCR §87705(e)(7)

Based on interviews and records review the licensee did not comply with the section cited above by not ensuring the staff responded to egress door alarm in a timely manner, resulting in injuries and hospitalization of R1. This posed a potential health, safety or personal rights risk to residents in care.

Read raw inspector notes

On 2/27/25 Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Angela Panushkina, conducted an unannounced CASE MANAGEMENT visit at this facility to issue deficiency in conjunction with complaint control # 31-AS-20241106150126. LPAs met with facility Executive Director (ED) and explained the reason for the visit. LPAs conducted a physical plant walk through, at approximately 9:20am, to ensure that the facility is in compliance under Title 22 California Code of Regulations. At 9:50am, LPAs requested staff and resident rosters. During the initial complaint visit on 11/7/2024, LPA Khurshudyan conducted interviews and records review and informed that on 11/3/2024 around 1:30am R1 attempted to awol from the Memory Care unit and tried to exit the egress door to Assisted Living area. S1 and S2 (nights shift caregiver and MedTech) attempted to redirect R1 back to Memory Care unit, however, R1 got aggressive and while kicking S1’s left knee lost their balance and hit their face on the door. First aid was provided right away and with the help of S1 and S2 R1 went to their room. The following day on 11/4/2024 around midnight R1 had another episode of aggressive behavior and another attempt to awol from the Memory Care unit. Despite several attempts of redirecting R1 to their room, R1 opened the back exit egress door and was able to go outside and fell on the concrete. LPA conducted tour and observed that the egress door did properly work, however, when the alarm went off the facility did not have sufficient night shift caregivers on the floor to prevent the incident happening. R1 was transported to the hospital for further evaluation. Lastly, LPAs were informed that the Memory Care Unit had total of fifty-five (55) residents, two (2) of which had wandering behaviors. Also, two (2) staff members were scheduled for the night shift to cover 1 st and 2 nd floors by providing care and supervision. During interviews ED and Memory Care director confirmed that R1 had wondering behavior and numerous episodes of incidents got recorded of R1 being agitated towards staff and other residents in care and the incident happened due to failing to respond to egress door alarm in a timely manner. Deficiencies are cited and noted on LIC 809D. Exit interview conducted. Appeal rights explained. Copy of this report signed and delivered.

2025-02-27
Complaint Investigation
Substantiated
Type B · 1 finding
Inspector · Angela Panushkina

Plain-language summary

A complaint investigation found that a staff member used a resident's emergency credit card to make unauthorized purchases totaling $4,554.38, including airline tickets, between receiving the card and late August 2024. The facility did not discover the fraud until the resident's power of attorney reviewed the credit card statement and reported it; the staff member was terminated on August 19, 2024, and a police report was filed. The investigation concluded that the facility failed to put adequate safeguards in place to protect residents' money, which allowed this theft to occur.

Type B22 CCR §87217(b)
Verbatim citation text · 22 CCR §87217(b)

Based on interviews and record reviews, licensee did not comply with the section cited above by failing to take appropriate measures to safeguard R1's credit card, resulting in fraudulent use. This posed a potential health, safety or personal rights risk to residents in care.

Read raw inspector notes

Allegation: Staff financially abused a resident in care. The investigation findings revealed that Resident #1 (R1) had been living at this facility since June 19 th , 2024, and was not able to manage own Cash Resources. Interview with R1’s Power of Attorney (POA) revealed that R1 was left with one (1) credit card for an emergency use only and the facility Business Director was aware of it. After receiving R1’s August 2024 credit card statement, POA discovered multiple charges made in the amount of $4,554.38. Upon discovery, POA immediately notified R1’s credit card fraud department and stopped the card for further usage. Since the card charges were used to purchase airline tickets, POA was provided with a name of the person who purchased the tickets. POA also notified the facility and was informed that the perpetrator is a Staff #1 (S1). LPAs conducted interviews with the Executive Director and Resident Care Director and were informed that the facility filed a police report. However, LPAs were also informed that S1 last worked on 07/26/2024, took Paid Time Off (PTO) and was scheduled to come back on 08/10/2024. S1 called out on 08/10/2024, 08/11/2024, 08/13/2024 and notified the facility that due to family emergency will not be available until 08/16/2024. On 08/16/2024, S1 did not show up to work nor called with any explanations. Instead, S1 sent a text on 08/17/2024 informing the facility that he/she failed to give the two (2) weeks’ notice. Due to S1’s history of attendance the facility terminated S1’s employment as of 08/19/2024. Although, the interview with the Executive Director and Resident Care Director revealed that they were unaware of the fraudulent activities until that information was provided to them by R1’s POA on 08/30/2024, the facility failed to take appropriate measures to safeguard residents’ cash resources which resulted in "Staff financially abusing a resident in care". Therefore, based on the information gathered, there is sufficient evidence to conclude that the above allegation is Substantiated. Deficiency issued per CA code of Regulations Title 22 on LIC-9099D Exit interview conducted, appeal rights explained, and a copy of this report signed and delivered.

2024-11-27
Other Visit
No findings
Inspector · Abeye Duguma

Plain-language summary

This was a required annual inspection visit, during which inspectors toured the facility and found the building, bedrooms, bathrooms, kitchen, and common areas to be clean and properly maintained, with appropriate safety features including working smoke and carbon monoxide detectors, secure storage of hazardous materials and medications, and adequate food and linens. Inspectors noted unpleasant odors in multiple rooms and hallways, which will be addressed separately through a complaint process. No other health and safety hazards were identified during the visit.

Read raw inspector notes

Licensing Program Analyst (LPA) Abeye Duguma, Perchui Milena Khurshudyan and Angelica Segovia met with the Executive Director, Ivan Saa, for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 10:00 AM and the following was noted: There is one main entrance being utilized at the facility. LPAs toured a random selection of resident rooms. All bedrooms were properly furnished and had appropriate bedding and linens. There were bathrooms in each of the resident rooms. Bathrooms were properly supplied and had functional fixtures. Hot water temperature measured between 106.4 and 118.5 degrees Fahrenheit. The facility is fire cleared for one hundred twenty of which one hundred (100) may be non-ambulatory and twenty (20) bedridden and a hospice waiver for twenty (20). The facility is currently occupying ninety-two (92) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for parking. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. (continued on LIC 809-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Kitchen closes at 7:00p.m. and reopens at 5:00a.m. The common and dining room are neat and clean. The facility maintains a comfortable temperature at 74°F. The smoke and carbon monoxide detectors are hardwired, interconnected and centralized with automatic dispatch to the Los Angeles Fire Department. Fire extinguishers located throughout the facility and observed to be fully charged and last inspected 09/06/2024. The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. Towels and washcloths are not shared. There was enough clean linen available in each resident room. During the physical plant tour, LPAs experienced malodor in multiple rooms and hallways. This will be addressed on complaint control 31-AS-20241126090947. LPAs observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit. No other health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.

2024-11-27
Complaint Investigation
Unsubstantiated
No findings
Inspector · Perchui Khurshudyan

Plain-language summary

A complaint alleged that staff mismanaged a resident's finances, but an investigation found no evidence of wrongdoing. The facility's billing department handles all resident payments, and the resident confirmed she has long-term care insurance that pays the facility directly and maintains control over her own finances.

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Between 1:15pm – 2:30pm LPA Khurshudyan interviewed the Executive Director, Assisted Living Director and R1. It was reported that Staff mismanages resident's funds. Records review, interviews with staff and R1 revealed that all finances are being handled by the billing department. Additionally, Staff at the facility has no control over any resident's finances. ED provided documents were it was stated that R1 has full control over her finances and her payments are supposed to be paid through her long term care insurance directly to the billing department. R1 also stated that she has long term care insurance and payments are paid through insurance. Based on interviews and documentation review, there is insufficient evidence to verify that staff mismanaged resident's finances. Therefore, the allegation above noted allegation is deemed UNSUBSTANTIATED at this time. Exit interview conducted and copy of this report signed and delivered.

2024-10-09
Complaint Investigation
Unsubstantiated
No findings
Inspector · Antonia Alvizar-Ettima

Plain-language summary

A complaint investigation found that a resident had died and staff did not discover it promptly due to alleged understaffing, and that residents were being locked in their rooms. The facility stated it has adequate staffing with checks every two hours, and that bedroom doors can only be locked from the outside by staff as a safety measure for wandering residents, with staff able to unlock them quickly with a master key. The investigator found insufficient evidence to support either allegation and noted no health and safety hazards during the visit.

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previously obtained from the facility. At the time of this visit at 11:10a.m., LPA Alvizar-Ettima and RCD conducted a physical plan tour. During inspection, at approximately 11:30a.m. LPA attempted to interview nine (09) out of fifty-five (55) residents residing at Generation Unit. However, they were unable to respond to LPA’s questions. 1. Due to insufficient staffing, resident was not checked on time. It was alleged that R1 passed away in their room and staff did not know R1 had passed due to short staffing. S taff interviews reveal that they have sufficient staffing to check on residents timely. Resident Care Director (RCD) indicated that Generation Unit has a total of five (05) staff during the morning and evening shifts. There are three (03) staff during night shift. Residents are being checked out every two hours and as needed. They did not receive any complain about insufficient staffing. During this visit LPA observed residents in Generation Unit and they appeared to be clean and well groomed. A review of facility staff schedule supported the information provided by the staff Based on observation, interviews and records review there is an insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. 2. Staff locked resident in room. It was alleged that staff would lock resident (R1) in room residing on the Generation Unit because R1 was a wander risk. Resident Care Director (RCD) and staff interviews reveal that the residents are not locked in the room. All bedroom doors can only be locked from inside by the resident. However, all staff members have a master key and can easily gain access. Interview with three (03) staff that provide care in the Generation Unit revealed that doors are always unlocked, when the resident is in the room, and the staff checks on them every two hours. Some residents carry their own key however they can always open the door from inside the room. RCD and staff indicated that when residents are out in common areas all resident doors are kept locked to prevent wandering residents from entering. During inspection, LPA visited five (05) random selected rooms including R1’s and observed that the door has no auto lock and can easily be opened. However, the door is kept locked from the outside and only a staff member with master key can gain access. Based on interviews and observation there is an insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No health and safety hazard are noted during this visit. Exit interview is conducted and copy of report was provided.

2024-09-12
Complaint Investigation
Substantiated
Type B · 1 finding
Inspector · Perchui Khurshudyan

Plain-language summary

During a complaint investigation, inspectors found that the facility's air conditioning system—one large unit serving 100 rooms plus four smaller units for hallways—had malfunctioned during heat waves, leaving some resident rooms uncomfortably warm at times. The facility moved residents to the dining area during repairs and provided portable air conditioners, and while temperatures were acceptable on the day of inspection, the pattern of AC failures was confirmed through staff interviews and maintenance records. The facility is working to upgrade its cooling system to better serve the building.

Type B22 CCR §87303(b)(2)
Verbatim citation text · 22 CCR §87303(b)(2)

Based on interviews, record review and observations, the licensee did not comply with the section cited above as the facility AC was not functioning properly in residents rooms which poses a potential Health, Safety, or Personal Rights risk to residents in care.

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Between 11:45am to 3:45pm LPA spoke with the Executive Director (ED) Ivan Saa, Maintenance Director (MD) Julio Arriaga, Generation Program Director (GPD) Diane Parras, and other staff, including Housekeepers and Caregivers attending residents residing in selected rooms. In addition LPA requested facility maintenance log documenting daily reports regarding repairs and reported issues with A/C system. Interviews revealed that the facility has one (1) 40 ton chiller for hundred (100) units/rooms and four (4) 3-5 ton AC for hallways and at times during heat wave A/C units may malfunction. Facility accommodated residents by providing portable ACs. ED Saa stated that during the portable AC installation process, residents were transferred to the dining area were the temperature was cool and more comfortable. Interview with Residents revealed the same information provided by the facility staff. A review of maintenance records verified the information received from interviews. ED stated that the facility is in the approval process of updating the AC system which will be more compatible with the large building. Although at the time of this visit the temperature in various resident’s rooms and common areas was within required range, based on the information revealed from interviews, and record review, there is a sufficient information to support the allegation. Therefore, the allegation is SUBSTANTIATED at this time. Under Title 22, Division 6, following citation was issued and recorded on LIC9099D. Maintenance and Operation 87303 (b)(2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. Exit interview was conducted, appeal rights discussed and a copy of report was issued.

2024-07-18
Complaint Investigation
Type B · 1 finding
Inspector · Perchui Khurshudyan

Plain-language summary

A complaint investigation found that the facility failed to submit required incident reports to the state licensing department for two events: a hospitalization on June 15, 2024, and a skin tear discovered on June 22, 2024. State regulations require such reports to be submitted within seven days, and the facility director acknowledged that no reports were filed. The facility was ordered to submit the overdue incident reports.

Type B22 CCR §87211(a)(1)(A)(B)(D)
Verbatim citation text · 22 CCR §87211(a)(1)(A)(B)(D)

Based on interviews and record reviews, conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding R1's hospitalization on 06/15/24, and skin tear on left forearm on 6/22/24 which poses a potential health and safety risk to persons in care.

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Licensing Program Analyst (LPA) Perchui Milena Khurshudyan, conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20240708170641. LPA met with the Assisted Living Director (ALD) Liliana Solorzano and explained the reason for the visit. During the visit, LPA was informed that R1 was taken to West Hills Hospital on 06/15/2024, where it was determined that R1 had to be hospitalized. R1 stayed in the hospital from 6/15/24-6/19/24. On 6/22/2024 S1 noticed a skin tear on R1's leftforearm and reported to med-tech. However, no incident report was submitted to the Community Care Licensing Department (CCLD) in a timely manner for both incidents. LPA reviewed all incident reports on a system and did not observe an Incident Report regarding R1. In addition, the ALD Solorzano admitted that no incident was submitted to the Regional Office (RO). Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPAs informed the ALD that all staff members are mandated reporters and they are all responsible for reporting. LPA informed ALD Solorzano to submit an incident report that occurred on: • 06/15/2024 • 06/22/2024 Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.

2024-03-14
Complaint Investigation
Unsubstantiated
No findings
Inspector · Huma Rahimi

Plain-language summary

A complaint alleged that staff unlawfully evicted a resident, but the investigation found no violation occurred. The resident was hospitalized in late November 2023, and after discharge in early December, the facility worked with the family to arrange higher-level care including a one-on-one caregiver; the resident's psychiatrist recommended transfer to another facility due to the resident's behavioral needs. The family decided to move the resident to a different facility four days after discharge without providing the standard 30-day notice.

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Staff unlawfully evicted a resident while in care: Regarding the above allegation, interviews with the Administrator, and Resident Care Director revealed that the facility did not issue an eviction notice to Resident # 1 (R1). R1 was hospitalized on 11/27/2023. Once the facility was notified of changes in R1’s level of care, the facility made necessary arrangements prior to R1’s discharge from the hospital on 12/04/2023. The Licensee completed a new care plan for R1 and communicated with R1’s responsible party to hire 1:1 caregiver due to R1’s higher level of care. Although, the facility discussed the changes with R1’s responsible party, and they agreed to new terms, the Psychiatrist suggested that it would be better for R1 to be moved to another facility due to having unexplained suicidal episodes that triggers him/her not wanting to be at this facility. Four (4) days later on12/08/23, after R1 got discharged from the hospital, R1’s family decided to relocate R1 to a new facility without giving the facility a 30-day notice. Lastly, the total balance for 1:1 caregiver, hired through a 3 rd party, was not paid by the family. Based on the interviews, review of the documents obtained, the allegation, “Staff unlawfully evicted a resident while in care” is unsubstantiated at this time.

2024-02-21
Complaint Investigation
Substantiated
Type B · 1 finding
Inspector · Angela Panushkina

Plain-language summary

A complaint investigation found that a staff member cashed forged checks from a resident's account without permission, totaling $8,140 over a five-month period in 2023, after finding the resident's checkbook in their car and failing to return it. The facility's leadership was unaware of the fraudulent activity until notified by investigators, but immediately suspended and then terminated the staff member once they learned what happened. The resident chose not to press charges.

Type B22 CCR §87205(a)
Verbatim citation text · 22 CCR §87205(a)

Based on interview and record reviews, licensee did not comply with the section cited above. Facility Staff #1 (S1) fanancially abused R1 by cashing nine (9) out of eleven (11) checks, which poses/posed a potential health and safety risk to resident in care.

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The complainant’s concern was that staff financially abused a resident in care by cashing personal checks. The investigation findings revealed that Resident #1 (R1) had been living at this facility since May 26 th , 2022. LPA reviewed the Admissions Agreement, Physician’s Report (dated on 05/12/2022), and Care Appraisal (dated on 10/30/23) which indicated that R1 is able to manage own Cash Resources. Interview with R1’s Trustee/Power of Attorney (POA) revealed that around October 2023, POA discovered that R1’s checkbook had gone missing. Upon discovery, POA placed a stop on all missing checks. However, no police report was filed. POA also informed LPA that during their review of the bank statements, POA discovered that eleven (11) checks were cashed and signatures on the checks were forged. Review of eleven (11) checks revealed that nine (9) out of eleven (11) check were payable to Staff #1 (S1). LPA interviewed S1 on (12/11/23) at (2:07pm). Interview revealed that on July 15, 2023, while taking a break, S1 found R1’s checkbook by an intersection near the facility and took it to their car. After the break, S1 returned to work and did not turn in the checkbook. Once S1’s shift was over at 10:30pm, S1 discovered that their car was stolen and filed a police report. However, S1 did not indicate in the report that R1’s checkbook was left in the car. Moreover, interview with S1 also revealed that as of 12/11/23, S1 failed to report the incident with R1’s checkbook to the Executive Director. Interviews with the Executive Director and a Business Office Director revealed that R1 never reported checks missing and they were unaware of the fraudulent activities, however when brought to their attention the Executive Director immediately placed S1 on a suspension and conducted their internal investigation. On 12/13/23, the Executive Director filed a Police Report and LPA receive a copy of the report on 02/19/24. Review of the Report revealed that R1’s checkbook disappeared from the room several months ago, but R1 was not aware about the transactions being made on his/her account until notified by R1’s attorney. Review of Police Report also indicated that R1 did not wish to prosecute. Lastly, Officer’s investigation revealed that nine checks were written to S1 for the amount of $8,140.00 and two checks to a person, not associated to this facility, for the amount of $1300.00. First check deposit was made on 06/29/23 and the last check was cashed on 11/30/23. During today's visit, the Executive Director informed LPA that as of 02/13/24, S1's employment was officially terminated. Based on the information gathered, there is sufficient evidence to conclude that the above allegation is Substantiated. Deficiency issued per CA code of Regulations Title 22 on LIC-9099D Exit interview conducted, appeal rights explained, and a copy of this report signed and delivered.

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