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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850091
Report Date: 09/04/2024
Date Signed: 09/04/2024 04:40:31 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
08/30/2024 and conducted by Evaluator Angela Barutyan
COMPLAINT CONTROL NUMBER: 29-AS-20240830143412
FACILITY NAME:PRESERVE AT WOODLAND HILLS, THEFACILITY NUMBER:
195850091
ADMINISTRATOR:MICHAEL OWENSFACILITY TYPE:
740
ADDRESS:6221 FALLBROOK AVENUETELEPHONE:
(747) 226-5834
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:60CENSUS: 35DATE:
09/04/2024
UNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Trevin WillisTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Licensee does not ensure that staff are adequately trained.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Angela Barutyan and Kelly Dulek arrived at the facility unannounced to conduct an initial complaint investigation for the allegation listed above at 09:38AM. LPAs met with staff and Executive Director (ED) Trevin Willis and explained the reason for the visit.

During today's visit, LPAs reviewed records, conducted interviews, conducted a brief physical plant tour at 10:56AM, conducted a medication review at 12:15PM, and obtained copies of pertinent documents.

Report continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
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 3
Control Number 29-AS-20240830143412
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: PRESERVE AT WOODLAND HILLS, THE
FACILITY NUMBER: 195850091
VISIT DATE: 09/04/2024
NARRATIVE
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It was alleged that the licensee does not ensure that staff are adequately trained. LPA Barutyan conducted an unannounced required annual visit on 08/07/2024 in which the facility received two (2) citations for incomplete 40 hours of initial training and 20 hours of annual continuation training. The plans of correction for the deficiencies cited on 08/07/2024 are still pending and have a due date of 09/06/2024. Based on record review and interviews, the allegation “licensee does not ensure that staff are adequately trained” is deemed SUBSTANTIATED at this time. While the allegation is substantiated, a deficiency will not be cited as the facility have open and pending plans of correction addressing personnel training. ED Willis has provided evidence of in-service training that has been conducted since 08/07/2024, and personnel are getting time allotted to complete online training at the facility.

Exit interview conducted, a copy of the report provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3