Navita Residences Ashwood

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced subsequent Case Management – Incident visit for the purpose of following up on a self-reported incident that occurred on 09/10/2025. Upon arrival, LPA was greeted by facility staff. Administrator was contacted via telephone and was read the report over the telephone. Entrance interview conducted. On 09/12/2025, an Unusual Incident/Injury Report was received at the Woodland Hills North Regional Office related to Resident #1 (R1). Written report indicates that on 09/10/2025 during the dinner hour, R1 had been seated at the dining table. Staff had left the area to assist other residents when R1 stood up unassisted, resulting in a fall. R1 was sent to the hospital, where it was determined R1 had sustained a fracture as a result of their fall. Additionally, R1 had a sepsis infection and passed away on 09/11/2025 while hospitalized. During an initial visit conducted on 09/17/2025, LPA interviewed Administrator related to the incident and LPA, along with Administrator, toured the pertinent areas of the facility at 11:08AM. No immediate health and safety hazards were identified during that visit. LPA also reviewed R1's file and obtained copies of pertinent documents. A copy of R1's death certificate was not available at the time of the visit. Administrator was informed that the incident was referred to Community Care Licensing Division’s Investigations Branch (IB) and that either the LPA or an IB investigator would follow up on the self-reported incident. IB Investigator Heidy Bendana obtained and reviewed copies of relevant documents, including but not limited to R1’s facility and hospital records, 911 call and incident report. Investigator Bendana conducted interviews with Administrator, facility staff, residents, and other relevant parties on the following dates:10/06/2025, Report Continued on LIC 809-C 11/21/2025, and 01/13/2026. LPA Dulek then reviewed all information obtained. The following was then determined: Interview revealed that on 09/10/2025, there were two (2) staff working at the facility with four (4) residents in care. Residents were just finishing up dinner when one Staff #1 (S1) took Resident #2 (R2) to the restroom. Resident #3 (R3) then expressed an urgent need to use the restroom, so Staff #2 (S2) took R3 to use the restroom, leaving R1 and Resident #4 (R4) at the table with no direct supervision. Before leaving the table, S2 told R1 to remain seated. Record review revealed that R1 ambulated using a walker, “can walk with one person support,” and R1’s appraisal needs and services indicated R1 was a fall risk and had an unsteady gait. Interview with Administrator confirmed R1 was a fall risk. Additionally, R1’s appraisal needs and service indicated R1 was able to follow directions but had “episodes of forgetfulness and intermittent confusion.” Incident report indicated that while both staff were away from the table assisting R2 and R3 with toileting, R1 fell when attempting to get up and/or walk unassisted. R4 yelled for staff assistance and reported the fall to care staff. S2 returned to the dining room and found R1 on the floor, lying on their side. R1 complained of left leg pain. S2 assisted R1 off the floor and into the dining room chair, called the Administrator and 9-1-1. Emergency personnel responded and transported R1 to the hospital. X-ray results revealed R1 sustained a left displaced femoral neck fracture as a result of the fall. R1’s records show R1 was a fall risk and had intermittent confusion but was left seated at the table with no direct supervision, which resulted in R1 falling and sustaining a fracture. Hospital documents indicate femoral fracture was complicated by severe encephalopathy, severe acidemia, and severely elevated lactate. R1 was admitted to the Intensive Care Unit (ICU) for additional monitoring. R1 passed away on 09/11/2025. Cause of death was listed as arteriosclerotic cardiovascular disease. Other significant condition contributing to the death but not resulting in the underlying cause was left hip fracture and unspecified dementia. While hospital records did indicate R1 had a urinary tract infection (UTI) at the time of their hospitalization, all parties interviewed indicated R1 showed no signs or symptoms of UTI while at the facility. Additionally, R1 did not have a fever, chills, abdominal or back pain upon admission to the hospital. Facility staff stated in the days leading up to the fall, R1 did not express any pain and was eating and drinking as normal. Staff did not observe any change of condition, therefore did not obtain medical attention prior to the fall. On 09/10/2025, when R1 fell, staff reported to the Administrator and called 9-1-1 timely. R1 did pass away in the hospital the day after R1 fell in the facility, however, R1’s cause of death was not directly attributed to R1’s fall while at the facility nor did the investigation reveal evidence to substantiate that the facility did not obtain timely medical attention related to R1’s UTI diagnosis. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to LIC 809-D.) A $500 Immediate Civil Penalty was assessed. Administrator was informed that additional civil penalties might be assessed based on health and safety code 1569.49(f). Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 11, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Mar 12, 2026

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c) This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the above cited section, as R1 was identified as a fall risk but was left unsupervised, resulting in R1 falling and sustaining a fracture, which posed an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 11, 2026

Plan of correction: Administrator agreed to provide additonal training for the staff related to resident care plans and basic service needs. Administrator will provide proof of training to CCL by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. LPA initially met with facility staff. Administrator was contacted via telephone and arrived at the facility at 10:20AM. Entrance interview conducted. Beginning at 11:08AM, the LPA along with the Administrator toured the facility inside and outside to ensure resident health and safety and the facility is in compliance with Title 22 regulation. The smoke alarms and carbon monoxide detectors were tested and functioned properly. The fire extinguishers were purchased on 8/3/2024 and appeared fully charged. BEDROOMS: The facility has seven (7) bedrooms total, one (1) of which is designated for staff use and six (6) are private resident rooms. All resident bedrooms were observed to contain a bed, chair, bedside table, dresser, and lighting. All resident rooms had appropriate bedding. There is an ample supply of linens and towels stored in the cabinets in the hallway. Bedrooms containing exit doors had functional auditory alarms. All residents have a wearable pendant to utilize when staff assistance is needed. RESTROOMS: The facility has three (3) full bathrooms for resident and staff use and one half bath located at the entry. All restrooms contained grab bars and slip-resistant surfaces. Hot water was measured at 109.9 degrees Fahrenheit, which is within the required range. COMMON AREAS: Paint, windows, blinds, and floors are in good repair. The common living and dining areas are clean and properly furnished. A working telephone is present. There is one (1) fireplace in the residence, which was properly screened at the time of the visit. Chemicals are stored in a locked cabinet in the laundry room and in the locked garage. Report Continued on LIC 809-C OUTDOOR SPACE: The facility does have a small birdbath in the backyard; currently no residents are identified as at risk with this water feature. Building and grounds are free from hazard. Patio area observed outdoor shaded seating area for resident use. The one (1) outdoor exit gate was observed to be self-closing and self-latching. KITCHEN: The kitchen contained a sufficient supply of dishes, glasses and utensils. The facility has a sufficient supply of non-perishable food, perishable food and an emergency supply of water is present. Knives are stored in a locked cabinet. Cleaning supplies were observed locked in a cabinet under the sink. The refrigerator/freezer was at the appropriate temperature (40*F and 0*F). RECORD REVIEW: Beginning at 10:09AM (resident files) and 11:33AM (staff files), the LPA began file review. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. All four (4) staff files and four (4) resident files observed were in compliance with regulation. All trainings were observed to be complete. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly, with the last drill documented on 06/30/2025. Emergency disaster plan was observed to be complete and updated annually, as required. MEDICATION REVIEW: Medications for two (2) residents were reviewed. Medications were observed stored in a locked cabinet. Medications were prepared for a 7-day period and not in their original containers. Centrally Stored Medication and Destruction Record (CSMDR) was missing start dates for residents' current medications. Start dates observed on individual bubble packs did not match the medication counts. LPA was unable to tell whether medications are being administered as prescribed due to the inaccurate start dates and medications not stored properly. Medication Administration Record (MAR) was observed to be initialed daily for the month of September. A complete medication audit was unable to be completed at this time due to the improper storage and documentation. INTERVIEWS: LPA interviewed two (2) residents and two (2) staff. No concerns noted. Report Continued on LIC 809-C DOCUMENTS REVIEWED/OBTAINED: During today's visit, the LPA reviewed a copy of the facility's register of facility clients, received a copy of the liability insurance and the facility's LIC 500. Pursuant to Title 22 of the CA Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to LIC 809-D). Exit interview conducted and copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 17, 2025

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced Case Management – Incident visit for the purpose of following up on a self-reported incident that occurred on 09/10/2025. Upon arrival, LPA was greeted by facility staff. Administrator was contacted via telephone and arrived at 10:20AM. Entrance interview conducted On 09/12/2025, an Unusual Incident/Injury Report was received at the Woodland Hills North Regional Office related to Resident #1 (R1). Written report indicates that on 09/10/2025 during the dinner hour, R1 had been seated at the dining table. Staff had left the area to assist other residents when R1 stood up unassisted, resulting in a fall. R1 was sent to the hospital, where it was determined R1 had sustained a fracture as a result of their fall. Additionally, R1 had a sepsis infection and passed away on 09/11/2025 while hospitalized. During today's visit, LPA interviewed Administrator related to the incident and LPA, along with Administrator, toured the pertinent areas of the facility at 11:08AM. No immediate health and safety hazards were identified during today’s visit. LPA also reviewed R1's file and obtained copies of pertinent documents. A copy of R1's death certificate was not available at the time of the visit. LPA may return at a later date if further investigation is warranted. No citations issued. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Sep 17, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Teresa Camara conducted a pre-licensing inspection. LPA met with administrator Karthiga "Karthi" Vijayakumar. The applicant has obtained fire clearance for five (5) non-ambulatory residents in bedrooms one (1) through five (5) and one (1) bedridden resident in room six (6) for a total capacity of six (6) residents. The proposed facility does have a dementia care plan and a hospice waiver for five (5). During today's visit at 10:55 a.m., administrator completed component III with the LPA. Beginning at 10:04 a.m., LPA inspected the proposed facility for fire safety, personal accommodations, and food service. The smoke alarms and carbon monoxide detectors were tested and functioned properly. The fire extinguishers were purchased on 8/3/2024 and appeared fully charged. Bedrooms: The proposed facility has seven (7) bedrooms total, one (1) of which is designated for staff use and six (6) are private resident rooms. The current model bedroom (room 5) was fully furnished and contained a bed, chair, bedside table, dresser, and lighting. The bed had appropriate bedding. There is furniture available for the other rooms if a new resident chooses to have a fully furnished room. There is an ample supply of linens and towels stored in the cabinets in the hallway.. Restrooms: The proposed facility has three (3) full bathrooms for resident use; one half bath located at the entry. LPA observed night-lights were present in the hallways. All restrooms contained grab bars and non-skid mats. Hot water was measured at 115.3 degrees Fahrenheit. Report Continued on LIC 809-C Report Continued from LIC 809 Common Areas: Paint, windows, blinds, and floors are in good repair. There are no firearms on the premises. The common living and dining areas are clean and properly furnished. A working telephone is present. There is one (1) fireplace in the residence, which was properly screened at the time of the visit. Chemicals are stored in a locked cabinet in the laundry room and in the locked garage. A locked medication closet is located near the entry area. First aid kit was observed to be complete. There were no bodies of water observed. Building and grounds are free from hazard. Patio area observed outdoor shaded seating area for resident use. The one (1) outdoor exit gate was observed to be self-closing and self-latching. Kitchen: The kitchen contained a sufficient supply of dishes, glasses and utensils. A seven-day supply of non-perishable food is present and an emergency supply of water is present. Knives are stored in a locked cabinet. Hot water was measured at 118.3 degrees Fahrenheit. The refrigerator/freezer was at the appropriate temperature (40*F and 0*F). This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. No deficiencies were observed. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 15, 2024

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: KARTHIGA VIJAYAKUMAR, SHAMIN MOHAMED Interview Method: Telephone interview On September 25, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Sep 25, 2024