195850546-9-24-2026-29-AS-KHEN-DYE8KL-20260929223519

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850546
Report Date: 09/24/2026
Date Signed: 09/24/2026 12:26:41 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
05/18/2026 and conducted by Evaluator Quoc Huynh

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20260518093949

FACILITY NAME:	SAVANT OF WOODLAND HILLS		FACILITY NUMBER:	195850546
ADMINISTRATOR:	SIDNEY, KEVAN		FACILITY TYPE:	740
ADDRESS:	21711 VENTURA BLVD		TELEPHONE:	(818) 582-5455
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY:	322	CENSUS: 153	DATE:	09/24/2026
		UNANNOUNCED	TIME BEGAN:	11:46 AM
MET WITH:	Kevan Sidney - Executive Director		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Due to staff neglect, resident sustained an injury due to a fall
Staff did not provide medical attention to resident in a timely manner
Staff administering medication to resident without consent from authorized representative

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Quoc Huynh conducted a subsequent complaint visit to deliver findings for the above allegations. The LPA arrived at 11:46AM and met with Executive Director (ED) Kevan Sidney. Entrance interview conducted.

On 05/18/2026, the LPA conducted an initial visit. Between 3:53PM and 4:18PM the LPA conducted a physical plant tour and reviewed and obtained pertinent documents. On 05/19/2026, additional documents were provided via email.

On 08/04/2026, the LPA conducted a subsequent visit. Between 10:26AM and 12:41PM, the LPA conducted a physical plant tour, interviewed one (1) resident and six (6) staff, and reviewed and obtained pertinent documents.

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026

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 4

Control Number 29-AS-20260518093949

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: SAVANT OF WOODLAND HILLS	FACILITY NUMBER: 195850546
	VISIT DATE: 09/24/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegations: “Due to staff neglect, resident sustained an injury due to a fall” and “Staff did not provide medical attention to resident in a timely manner”

It was reported that due to staff neglect, Resident #1 (R1) sustained an open wound injury resulting from a fall and was not provided medical attention in a timely manner. Physician’s Report dated 10/25/2025 documented diagnoses including Alzheimer’s dementia, osteoarthritis, myalgia, and repeated falls. The report also noted R1 exhibited disorientation and a lack of hazard awareness. Resident Assessment dated 10/31/2025, indicated that R1 required assistance with all activities of daily living (ADLs) and was identified as a fall risk requiring observation and fall management. R1 also received home health services with a primary diagnosis of an unspecified open wound on the right lower leg and a secondary diagnosis of unspecified dementia.

Interviews with staff revealed that R1 frequently attempted to stand and ambulate independently, which resulted in recurrent falls. Staff stated that R1 sustained minor bruising and skin tears to the legs and arm, which typically resembled minor scratches. Staff also reported that R1 often removed bandages applied to skin tears and that R1 was known to scratch and further irritate the wounds. Staff explained that R1 would be transported to the hospital following their falls if they experienced pain or suspected of hitting their head. Facility fall interventions included supervising residents in the activity room, redirecting behaviors, and providing activities to keep residents engaged. Staff stated that a 1:1 staff to resident ratio in the common areas had been effective with R1 due to restlessness; however, the facility was not equipped to maintain a 1:1 ratio. Staff #1 (S1) recalled an incident where R1 sustained a deeper skin tear on the elbow and was transported to the hospital but could not recall the date of occurrence. S1 was unsure what caused the injury but stated it could have resulted from any object within R1’s room during an attempt to get out of bed independently.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20260518093949

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: SAVANT OF WOODLAND HILLS	FACILITY NUMBER: 195850546
	VISIT DATE: 09/24/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The Department received a self-reported incident from the facility stating that on 01/12/2026 at approximately 3AM, R1 had an unwitnessed fall in their bedroom. R1 was observed with a skin tear on their right arm and left leg and subsequently transferred to the hospital via emergency services. Hospital records revealed that R1 was admitted to the emergency department at approximately 4:04AM. R1 was evaluated for a right forearm skin tear, received a wound dressing, and was provided new orders to irrigate the wound with saline. R1 was also evaluated and referred to general surgery for a right and left lower leg laceration before being discharged at approximately 7:12AM.

On 01/19/2026, R1’s home health nurse observed that the right forearm skin tear appeared to require medical attention due to signs of an infection. Hospital records indicated that R1 was transported to urgent care by family and that the skin laceration was documented as approximately one (1) week old and fall related. The laceration measured approximately five centimeters (5 cm), was V-shaped, and had macerated edges. The laceration was irrigated with normal saline and R1 was referred to general surgery and wound care for further management. Although urgent care records noted that the wound had not been previously evaluated by medical staff before 01/19/2026, hospital records from 01/12/2026 confirmed that it had been evaluated and treated. Home health records did not document any treatment or observation of the right forearm skin tear before or after R1’s hospital visits.

Facility Progress Notes did not document the unwitnessed fall on 01/12/2026 but did document R1’s return from the hospital with new medication orders the same day. Staff notes indicated that R1 remained stable in the following days, with home health’s observation of skin breakdown on R1’s right leg on 01/14/2026, an additional fall documented on 01/15/2026, and home health’s observation of an infected “right elbow” laceration. Home health records further documented skilled nursing visits completed approximately every two (2) days for wound care to R1’s lower extremities.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20260518093949

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: SAVANT OF WOODLAND HILLS	FACILITY NUMBER: 195850546
	VISIT DATE: 09/24/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based on interviews and record review, although R1 sustained a fall resulting in a skin laceration, there is insufficient evidence to prove the injury occurred due to staff neglect. Additionally, the facility took appropriate steps in contacting emergency services following the unwitnessed fall and observation of the skin laceration. Therefore, the allegations are deemed UNSUBSTANTIATED at this time.

Allegations: “Staff administering medication to resident without consent from authorized representative”

It was reported that the facility administered Mirtazapine and Quetiapine Fumarate medications without authorization from R1’s family. Staff reported that R1’s medications were managed by R1’s family, who obtained all prescription orders and provided the orders to the facility. Staff indicated that R1’s medications were listed on their medical provider’s portal and that the family did not expect to be notified of each prescribed medication.

Centrally stored medication and destruction records documented Mirtazapine 7.5MG was filled on 12/03/2025 and started on 12/04/2025 and Quetiapine Fumarate 25MG was filled on 01/12/2026 and started on 01/14/2026. Interview and documentation obtained from the prescribing pharmacy revealed that the pharmacy received telephonic prescriptions for both medications. Records indicated that Mirtazapine was prescribed by a physician and Quetiapine Fumarate was prescribed by a nurse practitioner with a Geriatric Psychiatry medical facility. Additionally, R1’s primary medical provider records showed that R1 had previously been prescribed Quetiapine Fumarate 25MG on 09/20/2025.

Based on interview and record review, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur; therefore, the alleged violation is deemed UNSUBSTANTIATED at this time.

No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 4