195850240-10-19-2023-29-AS-KHEN-D2WTYW-20240229140921

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850240
Report Date: 10/19/2023
Date Signed: 10/19/2023 03:47:12 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
10/16/2023 and conducted by Evaluator Christine Yee

COMPLAINT CONTROL NUMBER: 29-AS-20231016141337

FACILITY NAME:	VARIEL OF WOODLAND HILLS, THE		FACILITY NUMBER:	195850240
ADMINISTRATOR:	JOYCE AQUINO		FACILITY TYPE:	740
ADDRESS:	6233 VARIEL AVE		TELEPHONE:	(818) 651-6018
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	436	CENSUS: 300	DATE:	10/19/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Cassandra Moan, Director of Memory Care		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility is in disrepair (water)

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and initially met with Joyce Aquino, Administrator. Today's visit was conducted primarily with Cassandra Moan, Director of Memory Care. The reason for today's visit was explained.

On today's visit, LPA Yee conducted interviews with Cassandra Moan at 10:26am, Ray Rosales at 12:29pm, Jessica Saks at 1:06pm. LPA Yee also obtained copies of facility documents.

Per information received from interviews conducted today, there was a water main that burst and water was observed flooding the street on 10/11/23. Facility staff were able to turn off the water. Los Angeles Department of Water and Power(LADWP) were contacted by staff and they were on site to assess the

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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-20231016141337

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: VARIEL OF WOODLAND HILLS, THE	FACILITY NUMBER: 195850240
	VISIT DATE: 10/19/2023

NARRATIVE

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situation and they determined that the busted water main was on facility property and not their responsibility. Ray Rosales, Director of Engineering contacted a private contractor to conduct repairs the same day and the repairs were not anticipated to be completed until the morning of 10/12/23. The facility ordered drinking water and gallon sized bottles of water for use in the toilet. Arrangements were made to have food catered, additional staff were scheduled to work and residents given options to relocate to a nearby hotel. Group notifications were sent out via the facility's K4 system to advise all residents, family members and responsible representatives of the busted water main and the actions being taken to ensure that the residents are provided with water on 10/11/23. Flyers were also posted on residents' doors. The water main was repaired by noon on 10/12/23. When the water was turned back on, the pressure from the water main caused the pipes on the fourth floor, by room #421 of Building A, to leak. The water also went down to the third floor. The hallway walls on the fourth floor sustained water damage. The water had to be turned off again for repairs. The repairs were completed on 10/13/23 and water was restored to Building B and Building C. Residents located around the impacted area were also relocated to vacant rooms in building B and building C. Restoration of water supply to Building A was delayed by the availability of parts needed for the repair. As of this visit, the residents relocated are scheduled to return to their original rooms today. All residents continued to be provided with updates of the repairs. Residents also continued to be provided with care, food, water for drinking, toileting and shower while repairs were being conducted. The pipes were fixed and water supply was completely restored on 10/14/23.

Per the above allegation that the facility is in disrepair(water), LPA Yee was not able to conclusively determine that the water main burst as a result of facility neglect or inaction. It is unknown as to what caused the water main to burst and the resulting effects of the burst cannot be anticipated. The facility did the necessary repairs in a timely manner, provided the required resident care and resources to ensure the residents well being and therefore, the above allegation is unsubstantiated.

Exit interview was conducted.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC9099 (FAS) - (06/04)

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