197600430-5-23-2023-29-AS-DPEA-CU9U76-20230731151924

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197600430
Report Date: 05/23/2023
Date Signed: 05/23/2023 04:55:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/15/2022 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20221115115733

FACILITY NAME:	VALLEY VIEW RETIREMENT CENTER		FACILITY NUMBER:	197600430
ADMINISTRATOR:	JUDITH MONTOYA		FACILITY TYPE:	740
ADDRESS:	7720 WOODMAN AVE.		TELEPHONE:	(818) 997-6756
CITY:	PANORAMA CITY	STATE: CA	ZIP CODE:	91402
CAPACITY:	116	CENSUS: 69	DATE:	05/23/2023
		UNANNOUNCED	TIME BEGAN:	02:02 PM
MET WITH:	Judith Montoya, Administrator		TIME COMPLETED:	05:05 PM

ALLEGATION(S):

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Resident is being mistreated by other residents while in care.
Staff did not keep a resident's room free from bed bugs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi conducted a subsequent visit to this facility today to deliver findings. At 2:02 p.m., the LPA met with the Administrator, Judith Montoya and explained the reason for the visit.

During the initial visit on 11/21/2022 between 3:12 p.m. and 3:58 p.m., LPA Peraldi conducted a brief physical plant tour and conducted an interview with Staff #1 (S1). During todays visit, at 2:08 p.m., the LPA conducted an interview with the Administrator. On 05/23/2023, at 2:26 p.m., the LPA reviewed records and obtained copies of pertinent documents. On 05/23/2023, at 2:28 p.m., the LPA, along with the Administrator conducted a physical plant tour. On 05/23/2023, between 2:29 p.m. and 3:34 p.m., the LPA conducted interviews with eight (8) out of sixty-nine (69) residents, including Resident #1 (R1). On 05/23/2023, between 3:16 p.m. and 3:22 p.m., the LPA conducted interviews with three (3) staff.
Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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 3

Control Number 29-AS-20221115115733

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VIEW RETIREMENT CENTER	FACILITY NUMBER: 197600430
	VISIT DATE: 05/23/2023

NARRATIVE

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Regarding the allegation: Resident is being mistreated by other residents while in care. On 11/15/2022, the Department received a complaint in which it was alleged that Resident #1 (R1) was being bullied by other residents while at the facility. Interviews with the Administrator revealed that R1 had an argument with R1’s boyfriend, Resident #2 (R2) last year in November. The Administrator explained that R1 and R2 had an argument in the dinning room. The Administrator explained that staff in the dinning room attempted to deescalate the situation but that R1 and R2 told them to “mind their business.” The Administrator explained that the following day, the Administrator spoke with R1 regarding the argument with R2. The Administrator stated that R1 said that R1 and R2 are no longer arguing. The Administrator stated that on the following day of R1 and R2’s argument, the Administrator held an all staff meeting and training regarding the incident. The Administrator provided a copy of the Inservice Education Employee Training Sign-Up Sheet, dated November 22, 2022. The purpose of the training was for staff to ensure that R1 will be feeling safe and respected. At 3:34 p.m., the LPA conducted an interview with R1. R1 explained that R1 is feeling okay and has not had any issues with other residents. R1 did not mention being bullied by other residents. Furthermore, other resident interviews did not reveal that residents had issues with other residents. Staff interviews revealed that if residents are arguing or have issues with one and other, that staff intervene and deescalate the situation. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.

Regarding the allegation: Staff did not keep a resident's room free from bed bugs. On 11/15/2022, the Department received a complaint in which it was alleged that the facility had bed bugs. The interview with the Administrator revealed that there have not been bed bugs at the facility. The Administrator explained that the facility receives monthly pest control maintenance from a company called Western Exterminator Company. The Administrator explained that the monthly pest control maintenance includes both interior and exterior treatment of the building. The Administrator explained that if a resident has a bug or insect problem, the Administrator schedules Western Exterminator Company to treat the problem immediately. The Administrator provided the LPA copies of the most recent invoice from Western Exterminator Company, dating from November 2022 and March 2023. During today’s visit, the LPA observed eight (8) resident rooms. The rooms were observed to be furnished appropriately with clean linens. The LPA did not observe bed bugs in the rooms.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20221115115733

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VIEW RETIREMENT CENTER	FACILITY NUMBER: 197600430
	VISIT DATE: 05/23/2023

NARRATIVE

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The interviews with residents revealed that the residents have not observed bed bugs recently. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

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