195850091-12-11-2023-29-AS-DPEA-CZXTAG-20240129133327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850091
Report Date: 12/11/2023
Date Signed: 12/11/2023 04:37:44 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
12/08/2023 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20231208151409

FACILITY NAME:	PRESERVE AT WOODLAND HILLS, THE		FACILITY NUMBER:	195850091
ADMINISTRATOR:	TREVIN R WILLIS		FACILITY TYPE:	740
ADDRESS:	6221 FALLBROOK AVENUE		TELEPHONE:	(747) 226-5834
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	60	CENSUS: 50	DATE:	12/11/2023
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Trevin Willis		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Facility failed to conform with fire safety regulations

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted an initial complaint investigation visit regarding the above noted allegations. LPA met with administrator Trevin Willis and explained the reason for the visit.

At 11:30 LPA discussed the issue with a glass door separating the residents' dining room from the main entry lobby. At 11:47 a.m. LPA observed the door was locked and required a code to open or for the lock to be electronically released by the receptionist. It has a magnet that is connected to the fire system which will release the door in the event there is a fire. There is no delayed egress on this door. The Los Angeles Fire Department (LAFD) Inspector informed the facility on 12/8/2023 that this door is not in compliance with fire regulations.

(continued on 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231208151409

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: 12/11/2023

NARRATIVE

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(continued from 9099)

LPA conducted a brief tour of the facility starting at 11:35 a.m. Administrator demonstrated the LAFD approved delayed egress doors at the rear of the facility and the audible alarms attached to the doors. There is a 15 second delay on all three doors and when the alarm was triggered other staff responded quickly. There is a section in the facility that is for staff only; it houses the entry to the commercial kitchen, utility closet, laundry, storage and administrative offices. The door to reach this area remains locked at all times for the safety of the residents.

LPA and administrator discussed the newer glass door in the front which is installed in a glass partition wall that was added approximately 18 months ago. While this administrator was not working as the administrator of the facility at that time, it was his understanding permits were pulled and the addition of the wall and locked door was approved by LAFD and Community Care Licensing (CCL). However, during a recent annual inspection by the LAFD Inspector, the fire regulatory compliance of the door was questioned. The facility has been put on notice by LAFD that the door must have delayed egress and cannot remained locked while waiting for the repairs or replacement of the door.

The administrator stated today, 12/11/2023, he called their fire protection company, GFP (Guard Fire Protection System, Inc. GFP installed the magnetic lock on the door which is part of their fire system. He will have them come to the facility on an emergency basis to release the magnet so the door can remain unlocked until the delayed egress system can be installed. During the time this door is unlocked, the reception desk will remain staffed 24 hours a day to ensure residents do not exit the building unassisted by staff or a responsible party.

Based on the observations and interviews, the door in the lobby/reception area to exit the residents' dining room, was locked and did not have delayed egress. Therefore, the allegation the facility failed to conform with fire safety regulations is deemed SUBSTANTIATED at this time.

Pursuant to Title 22 of the CA Code of Regulations (CCR), the following deficiencies were cited (please refer to LIC 9099-D). Exit interview was conducted with the Administrator and report and appeal rights were reviewed and issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231208151409

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/11/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/12/2023 Section Cited CCR 87203	1 2 3 4 5 6 7	87203 Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator has contacted their fire protection system company to release the magnetic lock on the door by 12/12/2023. He will staff the reception area 24 hours/day until they can make the door delayed egress and LAFD inspects the door for compliance.
	8 9 10 11 12 13 14	Based on the investigation, observations and interviews, the licensee did not comply with the section cited above, as the door to exit the dining room to the lobby was locked and does not have delayed egress, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

LIC9099 (FAS) - (06/04)

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