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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850435
Report Date: 08/02/2024
Date Signed: 08/02/2024 04:32:31 PM


Document Has Been Signed on 08/02/2024 04:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:TRUE LIVING CARE LLCFACILITY NUMBER:
195850435
ADMINISTRATOR:HAVSGAARD, CHRISTIANFACILITY TYPE:
740
ADDRESS:22740 HATTERAS STREETTELEPHONE:
(951) 580-7888
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: DATE:
08/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:46 PM
MET WITH:Christian HavsgaardTIME COMPLETED:
04:35 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Angela Barutyan and Zabel Chochian conducted an unannounced case management - incident visit at 2:46PM. Upon arrival, LPAs met with staff and reason for visit was explained. Staff contacted Administrator who arrived at approximately 03:00PM. Reason for the visit was discussed with the Administrator Christian Havsgaard.

On 08/01/2024, the Department received an incident report stating that on 07/06/2024, two staff members were assisting Resident #1 (R1) when Staff #1 (S1) slapped R1. Staff #2 (S2) witnessed the incident and recognized it as abuse, but informed the Administrator later on 07/31/2024 due to fears of retaliation from S1 and Staff #3 (S3), the relative of S1.

During today’s visit, LPAs conducted a plant tour at 02:50PM of the facility which includes six (6) resident bedrooms, one (1) staff room, four (4) resident bathrooms, one (1) staff bathroom, kitchen, and common areas to ensure there are no health and safety hazards. LPAs conducted interviews with the Administrator at 03:25PM, two (2) staff members, and two (2) residents between 03:43PM-04:19PM, conducted a file review at 03:35PM, and obtained copies of pertinent documents relevant to the investigation.

Prior to issuing final licensing report, it has been determined that further investigation is needed at this time.



Exit Interview Conducted and Report was Issued.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angela BarutyanTELEPHONE: 747-922-1234
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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