195850240-3-5-2024-29-AS-DPEA-D3SUSQ-20240328155043

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850240
Report Date: 03/04/2024
Date Signed: 03/05/2024 08:44:35 AM

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
02/29/2024 and conducted by Evaluator Valeria Conway

COMPLAINT CONTROL NUMBER: 29-AS-20240229140541

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: 347	DATE:	03/04/2024
		UNANNOUNCED	TIME BEGAN:	09:38 AM
MET WITH:	Joyce Aquino		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Facility dishwasher is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced initial 10-day complaint visit to investigate the allegation listed above. Upon arrival LPA met with Administrator Joyce Aquino and explained the reason for the visit. Entrance interview conducted.

During today’s visit, at 10:00 a.m. LPA conducted a tour of the physical plant. Between 10:15 a.m. and 3:12 p.m., LPA conducted interviews with facility administrator, and a random sample of facility staff and residents. Additionally, at 11:45 a.m., LPA obtained and reviewed copies of pertinent documentation relevant to the investigation.

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

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 5

Control Number 29-AS-20240229140541

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: 03/04/2024

NARRATIVE

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Continued from LIC 9099

It was alleged that facility dishwasher is in disrepair and there are piles of unwashed dishes and utensils in the kitchen. It was further reported that residents are served meals in dirty dishes and are given dirty utensils. During today’s visit, LPA observed residents having meal services in the dinning area. All serving ware and utensils appeared to be clean and sanitary at the time. Additionally, LPA also observed a surplus of additional dishes stores in cabinets for emergency use. During the physical plant tour, LPA observed the dishwasher to be functioning properly. Moreover, LPA observed staff pre rinsing the dishes prior to loading them in the dishwasher to avoid any issues. A review of Work Order records reflected that on 09/20/2023, the dishwasher was not in working order; however, maintenance was immediately contacted, and the dishwasher was repaired the same day. Interviews conducted with staff and residents did not reflect any concerns regarding dirty dishes or utensils. 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 “facility dishwasher is in disrepair” is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report and appeal rights provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

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
02/29/2024 and conducted by Evaluator Valeria Conway

COMPLAINT CONTROL NUMBER: 29-AS-20240229140541

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: 347	DATE:	03/04/2024
		UNANNOUNCED	TIME BEGAN:	09:38 AM
MET WITH:	Joyce Aquino		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Facility staff are not following general food service requirements

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

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

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 29-AS-20240229140541

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: 03/04/2024

NARRATIVE

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Continued from LIC-9099
It was also alleged that facility staff are not following general food service requirements. Per the RP, staff touch food after touching their clothing, the ice cream freezer is dirty, and staff serve old ice cream to residents. Interviews conducted did not reflect any concerns regarding unsanitary food handling practices by staff. LPA observed some kitchen staff with gloves practicing good hand hygiene. However, during today’s visit, LPA observed multiple open/uncovered tubs of ice cream in the freezer. Interviews reflected that the tubs are covered at the end of the day/shift but not after each use. Moreover, LPA toured the kitchen again at 2:45 p.m., and observed that all the ice cream tubs were moved from one freezer to other. Per information gathered, staff stated that the freezer was not unplugged therefore, the ice cream tubs needed to be moved to a different freezer. Staff agreed to properly cover and label all ice cream tubs. Based on the information gathered, the department has sufficient evidence to determine that “staff are not following general food service requirements”. Therefore, the above allegation is SUBSTANTAITED at this time.

Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 9099-D)

Exit interview conducted. Citations issued. A Copy of report and appeal rights provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 29-AS-20240229140541

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/04/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/11/2024 Section Cited CCR 87555(b)(23)	1 2 3 4 5 6 7	General Food Service Requirements. (b) The following food service requirements shall apply: All readily perishable foods or beverages capable of... which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures.	1 2 3 4 5 6 7	Administrator agrees to provide trainig regarding General food service requierement by POC due date.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on observation and interviews, licensee did not comply with the section above by not covering and labeling the multiple ice cream tubs in the freezer, which is a potential 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) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

LIC9099 (FAS) - (06/04)

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