197603296-12-7-2023-31-AS-NMAN-D27SHW-20240206125412

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603296
Report Date: 12/07/2023
Date Signed: 12/07/2023 04:15:53 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/04/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20231204104907

FACILITY NAME:	FAIRWINDS - WEST HILLS		FACILITY NUMBER:	197603296
ADMINISTRATOR:	ELVIS GUTIERREZ		FACILITY TYPE:	740
ADDRESS:	8138 WOODLAKE AVE		TELEPHONE:	(818) 713-0900
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91304
CAPACITY:	130	CENSUS: 106	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Elvis Gutierrez		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff do not ensure food served is of good quality for residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to the facility to investigate the above allegation. LPA met with Executive Director, Elvis Gutierrez, and explained the reason for the visit.

--- Staff do not ensure food served is of good quality for residents in care

It was alleged that the facility served food that caused resident to be sick and food is left on the counter for an extended time. To investigate the allegation, on 12/07/2023, LPA conducted a physical plant tour at around at 11:00 AM, requested the resident roster at 12:00 PM, interviewed three (03) staff from 12:15 PM – 1:30 PM and interviewed ten (10) residents from around 1:30 PM – 3:30 PM. During the physical plant tour, LPA observed fresh food being prepared and served immediately.

(CONT. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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 31-AS-20231204104907

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: FAIRWINDS - WEST HILLS	FACILITY NUMBER: 197603296
	VISIT DATE: 12/07/2023

NARRATIVE

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A review of the resident roster revealed that resident mentioned in the allegation is not a resident at the facility and is unknown to staff. During interviews with staff, all staff stated that food is served fresh and that they are not aware of any complaints as it pertains to food. All residents stated they are satisfied with the quality of the food, that it is always served fresh and have no digestive issues caused by the food served.

Based on interviews, there is enough not information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards were noted during the visit.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

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