197605806-1-9-2024-28-AS-TAGD-CZRVH6-20240123152636

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197605806
Report Date: 01/09/2024
Date Signed: 01/09/2024 02:14:03 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
02/15/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 28-AS-20230215135802

FACILITY NAME:	LAS CASITAS ASSISTED LIVING		FACILITY NUMBER:	197605806
ADMINISTRATOR:	NATALIE GONZALEZ		FACILITY TYPE:	740
ADDRESS:	1633-1645 N. HOLLYWOOD WAY		TELEPHONE:	(818) 238-9951
CITY:	BURBANK	STATE: CA	ZIP CODE:	91505
CAPACITY:	17	CENSUS: 12	DATE:	01/09/2024
		UNANNOUNCED	TIME BEGAN:	12:27 PM
MET WITH:	Patricia Garcia - Manager		TIME COMPLETED:	02:13 PM

ALLEGATION(S):

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Staff did not ensure facility was free from pest resulting in resident sustaining multiple injuries

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted a subsequent complaint investigation at the above facility to address the above allegation. LPA Tan was met by House manager Patricia Garcia and explained that the purpose of this visit was to deliver findings for this complaint.

The investigation consisted of the following:

On 02/15/2023 LPA Agard initiated a complaint investigation. LPA toured the facility, conducted interviews, and requested records. All records were received at the time of visit.

(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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 28-AS-20230215135802

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LAS CASITAS ASSISTED LIVING	FACILITY NUMBER: 197605806
	VISIT DATE: 01/09/2024

NARRATIVE

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(continued from LIC 9099)

The investigation revealed the following: Regarding the allegation” Staff did not ensure facility was free from pest resulting in resident sustaining multiple injuries” It’s being alleged that Resident #1 (R1) sustained multiple bites on R1's neck and shoulder from a rodent. LPA attempted interviews with ten (10) out of fourteen (14) residents in total. Based on the attempted interviews, no residents were able to confirm the allegation as true. LPA attempted interviews with two (2) out of seven (7) staff in total. Both staff state that they observed R1 in distress and an unidentifiable rodent running from the resident’s bed. Paramedics were contacted and arrived at the facility to transport R1 to the hospital but informed the facility staff the request was considered a non-emergency due to the wound resembling a scratch. LPA Agard confirmed the facility receives pest control services monthly.

Based on the interviews conducted and records available, the allegation is deemed unsubstantiated.

An exit interview was conducted and a copy of this report was given.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC9099 (FAS) - (06/04)

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