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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191201867
Report Date: 02/24/2025
Date Signed: 02/24/2025 03:39:15 PM

Unfounded


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
02/21/2025 and conducted by Evaluator Erica Mosley
COMPLAINT CONTROL NUMBER: 29-AS-20250221153403
FACILITY NAME:EISENBERG VLG OF THE LA JEWISH HOME FOR THE AGINGFACILITY NUMBER:
191201867
ADMINISTRATOR:GLASS, KATHLEEN K.FACILITY TYPE:
740
ADDRESS:18855 VICTORY BOULEVARDTELEPHONE:
(818) 774-3000
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:271CENSUS: 80DATE:
02/24/2025
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Kathleen K. Glass (ED)TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Questionable Death
Facility staff did not seek timely medical attention for resident
Staff neglect led to resident sustaining hip fracture
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct an initial 10-day complaint visit for the above allegations. On today’s visit at 2:20 pm LPA Mosley met with Executive Director (ED) Kathleen Glass and explained the reason for the visit.

On 2/21/2025 the Department received a complaint regarding the following allegations: Questionable Death, Facility staff did not seek timely medical attention for resident, and Staff neglect led to resident sustaining hip fracture. It is the concern of the Reporting Party (RP) that Resident #1 (R1) had sustained a hip fracture, and soon after died as a result of negligence from the facility.

Report continued on LIC 9099-C...
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
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 2
Control Number 29-AS-20250221153403
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: EISENBERG VLG OF THE LA JEWISH HOME FOR THE AGING
FACILITY NUMBER: 191201867
VISIT DATE: 02/24/2025
NARRATIVE
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Report continued from LIC 9099...
To investigate this complaint, LPA obtained pertinent documents relevant to the investigation and interviewed the ED at 2:21pm. Interview with the ED and documentation received revealed that R1 did not reside at Eisenberg Village of the LA Jewish Home for the Aging 191201867 licensed by Community Care Licensing Division (CCLD). However, the resident resided at the Eisenberg Village Skilled Nursing Facility which is all on the same property and is licensed by a different regulatory agency of which CCLD has no jurisdiction over. Based on the information obtained, the allegations are deemed UNFOUNDED at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis.
Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2