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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850240
Report Date: 02/29/2024
Date Signed: 02/29/2024 02:50:39 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
02/20/2024 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20240220162640
FACILITY NAME:VARIEL OF WOODLAND HILLS, THEFACILITY NUMBER:
195850240
ADMINISTRATOR:JOYCE AQUINOFACILITY TYPE:
740
ADDRESS:6233 VARIEL AVETELEPHONE:
(818) 651-6018
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:436CENSUS: 353DATE:
02/29/2024
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Jessica Saks-DON and Joyce Aquino AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff failed to act appropiately to incident with resident

Failure to comply with reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Valeria Conway and Emily Peraldi conducted an unannounced initial complaint visit to this facility. At 9:55 a.m., the LPAs met with staff and explained the reason for the visit. At 10:00 a.m., the LPAs met with the Director of Nursing, Jessica Saks.

At 10:30 a.m., the LPAs conducted an interview with the Director of Nursing. At 10:42 a.m., the LPAs along with the Director of Nursing, conducted a physical plant tour. Between 11:07 a.m. and 2:15 p.m., the LPAs conducted interviews with seven (7) residents and four (4) staff. At 12:10 p.m., the LPAs spoke with the Administrator, Joyce Aquino. At 12:13 p.m., the LPAs reviewed records and requested copies of pertinent documents. At 12:25 p.m., LPA Conway conducted a telephonic interview with resident’s family member.

Continue on LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria ConwayTELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
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 2
Control Number 29-AS-20240220162640
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: 02/29/2024
NARRATIVE
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Regarding the allegations:1- Staff failed to act appropriately to incident with resident. 2- Failure to comply with reporting requirements. On 2/20/2024, the Department received a complaint alleging that Resident #1 (R1) slapped Resident #2 (R2) in front of staff in the memory care unit and that staff did not intervene. The complaint is also alleging that facility staff did not report the incident. The complainant alleged that R1 and R2 are husband and wife but was not sure if both R1 and R2 are residents of the facility. The complainant alleged that the incident occurred in December 2023, but the complainant did not provide any additional information. During the physical plant tour, the LPAs observed cameras in the Memory care unit however cameras facing common areas were installed beginning of February 2024. The LPAs were not able to obtain camera footage of the memory care unit common areas for the month of December 2023. During the time of the visit, the LPAs conducted an interview with the Director of Nursing, Jessica Saks. The Director of Nursing stated that R1 has not shown aggressive behavior in the past. The Director of Nursing stated that R1 and R2 get along well. The Director of Nursing explained that if facility staff witness an altercation or an incident, they report it to their supervisor and they also document it in their end of shift notes. Interview conducted with R1’s and R2’s family member revealed R1 and R2 have no history of being aggressive towards one another. R1’s and R2’s family member explained that R1 and R2 tend to speak loudly since both have hearing issues. R1 and R2’s family member did not voice concerns regarding facility staff or regarding the care of R1 and R2. Interview with R2 revealed that R2 feels safe around R1 and did not bring up any concerns regarding R1. Also, during the time of the visit, interviews with staff members denied the allegation and stated that R1 is not aggressive and that they have not witnessed R1 hit R2. Interviews with staff members revealed that if residents are arguing or have issues with one and other, that staff intervene and call other staff for additional assistance. Staff interviews also revealed that staff report any incidents to their supervisors and at the end of their shift they document any incidents or changes within their residents. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegations 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 allegation is Unsubstantiated.

Exit interview conducted. A copy of the report was provided.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria ConwayTELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2