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Inspection visit

complaint

PEARL OF WEST HILLS, INCLicense 1976098893 citations on this visit
3 citations recorded

Inspector’s narrative

What the inspector wrote

On 5/27/2021 Investigator conducted review of the Los Angeles Police Department (LAPD) Incident report which documented that the police were called to the facility for a welfare check. During the call officers spoke with licensee/administrator, hospice nurse, and R1’s responsible party. The LAPD report documented “The Reason and Cause of Injury as: Accident, Fall. The Extent of Injury: Minor” Information obtained during the course of the investigation revealed the following: On 3/27/2021 R1 was very agitated at the facility. Due to the agitation resident was running around the facility and ran into the facilities closed sliding door hitting his/her face. After the incident Administrator contacted the hospice agency. Hospice nurse visited R1 and completed an assessment. Administrator also contacted R1’s responsible party/family to notify them of the incident. Based on the lack of witnesses and evidence to corroborate the allegations Investigator Patterson has determined the allegations to be Unsubstantiated at this time. Facility increased resident's rate without proper notice: In regard to the allegation it was reported that the licensee/administrator increased Resident 1 (R1’s) fees several times after admission to the facility without providing proper notice. During the initial 10-day complaint visit which was conducted on 4/20/2021 LPA conducted interview with the administrator Irina Karbachinsky. When interviewed the Administrator denied raising R1’s monthly fees. On 10/17/2021 LPA conducted interview with R1’s responsible party/family who also denied that the R1’s fees were increased from the initial agreed upon rate. Based on the information obtained from the interviews conducted the allegation is Unsubstantiated at this time. Exit interview conducted and copy of report emailed to the administrator IRINA_KARBACHINSKIY@HOTMAIL.COM On 10/17/2021 LPA conducted review of the submitted CSMDR, hospice medication list for March and April 2021. Records reviewed revealed that R1 does not have a prescription for Geodon, and the medication is not listed/documented in facility, hospital, hospice records or any of the submitted/reviewed records. Additionally, LPA conducted medication count utilizing the photos taken of the medications in bubble packs on 4/20/2021. LPA also used the information provided by the licensee such as the start dates, hospitalization dates and the order dates listed on the hospice records. Medication count revealed the following: R1’s medications were not assisted with as prescribed. R1 was given additional doses of various medications. (7 extra pills of temazepam, 4 extra pills of melatonin, 25 (21 and 4) extra pills of Quetiapine/Seroquel from 2 different prescriptions. During the 4/20/2021 visit the administrator did not provide the medication Lorazepam/Ativan for LPA to review. The medication was also not listed in the March 2021 CSMDR. Medication documentation reviewed also revealed inconsistencies with the hospice medication list, licensees CSMDR and the medication orders on the bubble packs. Based on the medications counted and records reviewed the allegation is Substantiated. Exit interview conducted, copy of report citations and appeal rights emailed to the administrator IRINA_KARBACHINSKIY@HOTMAIL.COM

Citations

5 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87355(e)(2)Type A

    (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) orThis requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above by not transferring criminal record clearance for staff 1 (S1) to this facility prior to employment which poses an immediate health, safety or personal rights risk to persons in care.

  • 87406(g)Type A

    87406 Administrator Certification Requirements (g) Certificates issued under this section shall be renewed every two (2) years provided the certificate holder hascomplied with all renewal requirements.This requirement is not met as evidenced by: Based on review of records and interview with licensee which revealed the Licensees Administrator Certificate expired 08/08/2020 and the Administrator has not taken the required classes to renew the required Administrator Certificate which poses an immediate health, safety and personal rights risk to residents in care.

  • 87465(c)(2)Type A

    (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff shall be permitted to assist the resident with self-administration, provided the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions.This requirement was not met as evidenced by: Based on medication review the licensee did not comply with the cited sections by not giving medications per the physicians directions which posed an immediate health, safety and personal rights risk to R1.

  • 87465(C3)(D3)Type A

    If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date & time the PRN medication was taken, the dosage taken, & the resident's response.This requirement was not met as evidenced by: Based on records review and interview the licensee did not comply with the cited sections by not documenting when PRN medications were administered to R1. Which posed an

  • 87465(e)Type A

    (e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement was not met as evidenced by: Based on hospital records review the licensee did not comply with the section cited above by not having a signed written order from a physician for the medication Geodon given to resident 1 which posed an immediate health, safety and personal rights risk to R1.

FAQ · About this visit

Common questions about this visit

What happened during the November 5, 2021 inspection of PEARL OF WEST HILLS, INC?

This was a complaint inspection of PEARL OF WEST HILLS, INC on November 5, 2021. 3 citations were issued: 3 Type A (serious).

Were any citations issued to PEARL OF WEST HILLS, INC on November 5, 2021?

Yes, 3 citations were issued (3 Type A, 0 Type B). The first citation was for: "(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prio..."

What type of inspection was this?

This was a complaint inspection. Complaint inspections are triggered when someone reports a concern about the facility to CCLD.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.