197600430-9-12-2024-29-AS-KLOZ-DAGSJE-20241028135502

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197600430
Report Date: 09/12/2024
Date Signed: 09/12/2024 02:47:42 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
06/04/2024 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20240604100921

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: 72	DATE:	09/12/2024
		UNANNOUNCED	TIME BEGAN:	10:48 AM
MET WITH:	Judith Montoya		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff do not prevent resident from being harassed by other resident(s).
Staff do not ensure that resident's personal possessions are safeguarded.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent unannounced visit to investigate the allegations listed above. The LPA arrived at the facility and met with Judith Montoya and explained the reason for the visit.
On 06/06/2024, Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegations listed above. The LPA arrived and met with Med Tech-Supervisor Rosalba Monarrez and explained the reason for the visit. The Administrator Judith Montoya, arrive after at approximately 1:40p.m. and the LPA explained the reason for the visit. LPA Urena interviewed staff, residents, and the administrator between 12:30 p.m. and 2:30p.m. The LPA requested documents pertinent to the investigation.
Continues on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240604100921

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: VALLEY VIEW RETIREMENT CENTER	FACILITY NUMBER: 197600430
	VISIT DATE: 09/12/2024

NARRATIVE

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Pg.2

Staff do not prevent resident from being harassed by other resident(s). On the allegation that staff are not preventing residents from harassing fellow roommates, it is the concern of the Reporting Party (RP) that resident 1(R1) has been threatened by other residents with comments about actions that they may take against R1. To investigate the allegation LPA Urena interview residents and staff. The LPA attempted to interview the RP but was unable to reach them on the phone. The LPA interviewed R1 about the alleged harassment by other residents, and R1 stated that some residents make comments while R1 is in the dining room, in the hallway or when R1 leaves their room door open; R1 could not provide dates or times of the alleged incidents. However, R1 stated that the harassment started a couple of years back. LPA asked if R1 had asked the other residents to stop, and R1 stated yes, but they continue the alleged harassment. LPA asked if they had brought up the incidents to staff, and R1 said, 'yes'. The LPA interviewed residents about the alleged threats of residents against other residents in the facility. The residents interviewed stated that they have not witnessed, experienced, heard or made any threats directed to R1, or to anyone else. LPA Urena interviewed the dining area staff and caregiver staff about the allegation, and staff stated that they have not witnessed or heard any residents making threats to other residents, and if they did, they would bring it up to the administrator. Staff interviews revealed that if residents are arguing or have issues with one and other, staff intervene and de-escalate the situation. The LPA interviewed the administrator about the alleged threats and harassment, and the administrator stated that they are not aware of anyone being harassed. The administrator added that a similar allegation was brought up back in November of 2022, however that was resolved, and no other incidents have been brought up to their attention.

Although the allegation may have happened or is valid, based on the interviews, and record review there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240604100921

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: VALLEY VIEW RETIREMENT CENTER	FACILITY NUMBER: 197600430
	VISIT DATE: 09/12/2024

NARRATIVE

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Staff do not ensure that resident's personal possessions are safeguarded.
On the allegation that staff do not ensure that residents belongings are safeguarded, the RP’s concern is that R1 alleges that personal items have gone missing from their room. The LPA interviewed R1 about the items missing from their room, and the R1 stated that there was a specific item that they had purchased and kept in their room and a couple of other items. R1 stated that they have not been able to find it. When the LPA asked if they remembered the last time they saw the item(s), R1 could not remember. LPA asked R1 if they informed the administrator about the missing items, and R1 stated that they had not, 'because they don’t do anything about it'. The LPA interviewed residents about missing any personal items from their room, and the residents stated that they have not lost or missed any personal items. The LPA interviewed staff about the protocol that is followed if a resident informs them of missing personal items from their room, and the staff stated that they try to assist residents in looking for the missing items, and also inform the administrator. The administrator stated that residents do inform them if they happen to be missing something, the staff will help them look for the item(s), and usually the items are found in their rooms.

Although the allegation may have happened or is valid, based on the interviews there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

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

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC9099 (FAS) - (06/04)

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