195850091-8-13-2024-29-AS-KHEN-D8EPQX-20240823113150

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850091
Report Date: 08/13/2024
Date Signed: 08/13/2024 03:27:52 PM

Unsubstantiated

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
07/31/2024 and conducted by Evaluator Angela Barutyan

COMPLAINT CONTROL NUMBER: 29-AS-20240731164044

FACILITY NAME:	PRESERVE AT WOODLAND HILLS, THE		FACILITY NUMBER:	195850091
ADMINISTRATOR:	MICHAEL OWENS		FACILITY TYPE:	740
ADDRESS:	6221 FALLBROOK AVENUE		TELEPHONE:	(747) 226-5834
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	60	CENSUS: 40	DATE:	08/13/2024
		UNANNOUNCED	TIME BEGAN:	09:46 AM
MET WITH:	Trevin Willis		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff handle residents in a rough manner.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Angela Barutyan and Emily Peraldi arrived at the facility unannounced to conduct a subsequent complaint investigation for the allegation listed above at 09:46AM. LPAs met with staff and Executive Director (ED) Trevin Willis and explained the reason for the visit.

During today's visit, LPAs reviewed resident records and conducted a medication review. During the initial complaint visit which took place on 08/07/2024 beginning at 09:47AM, LPAs spoke with Administrator/ED, reviewed and obtained copies of pertinent documents, reviewed staff personnel records, interviewed 4 (four) staff and 5 (five) residents, and toured the facility with facility staff at 12:48PM.

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angela Barutyan	TELEPHONE: 747-922-1234
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

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-20240731164044

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: 08/13/2024

NARRATIVE

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It was reported that staff handled resident in a rough manner, and that specifically Staff 1 (S1) and Staff 2 (S2) have been observed to handle residents roughly. The complainant alleged that either S1 or S2 grabbed a resident roughly, resulting in a skin tear. The complainant did not provide specific resident names. Interviews conducted with four (4) staff revealed that staff have not observed or heard of other staff rough-handling residents, but that there are certain staff members, Staff 3 (S3), Staff 4 (S4), and Staff 5 (S5), who are neglectful and not properly trained. Staff members have reported S3, S4, and S5 before to the previous administration, but concerns were ignored. LPAs’ interview with five (5) residents and responsible parties of residents in care revealed that no one expressed any potential or immediate concerns for staff servicing the residents at this time. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff handled resident in a rough manner” is deemed UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angela Barutyan	TELEPHONE: 747-922-1234
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC9099 (FAS) - (06/04)

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