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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 11:30:31 AM


Document Has Been Signed on 08/02/2024 11:30 AM - 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: 4DATE:
08/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Christian HavsgaardTIME COMPLETED:
11:30 AM
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Licensing Program Analysts (LPAs) Brian Balisi and Trevor Byrne conducted an unannounced Case Management – Incident visit at 9:30 a.m. for the purpose of investigating self-reported incident reports. Upon arrival, LPAs met with Program Director Christian Havsgaard and explained the reason for the visit.

On 08/01/2024, the Department reviewed an incident report stating on 07/12/2024, Staff #1 (S1) was inside resident 1’s (R1) room. R1 is not bedridden but is unable to leave their bed without assistance. R1 stated that they required a cleaning that day, R1 requires a two (2) person assist with cleaning. S1 was alone at the time of the request but told R1 that they could perform the cleaning by themselves. R1 refused stating that it was unsafe for both of them, and two (2) people are required. S1 continually insisted that they could perform the cleaning solo but R1 continually refused. R1 stated that S1 was verbally abusive during the exchange. On 07/22/2024 after changing the sheets on R1s bed R1 asked S1 and Staff #2 (S2) to shift her bed. S1 and S2 began trying to shift the bed without unlocking the wheels. R1 informed the staff members that they had to unlock the wheels at which point S1 began being verbally aggressive towards the resident. S1 raised their fists at R1 and asked if the resident wanted to fight them. R1 confirmed that S1 has been verbally abusive on multiple occasions. On 07/06/2024 S2 and staff #3 (S3) were assisting resident #2 (R2) in the restroom. R2 leaned to the side and at this point S2 struck R2 in the head to straighten their body. S3 told S2 that this is elder abuse and they needed to stop. S2 stated that it is only elder abuse if it is reported. The department received the SOC341 for this incident on 08/02/2024.

At approx. 09:35 a.m., LPAs conducted physical plant, interviewed staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation. LPAs have determined further investigation is needed and will return at a later date to continue.
Exit interview conducted. A copy of the report was issued.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
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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