197607575-5-2-2022-29-AS-JAPL-CE6JW8-20220506072415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607575
Report Date: 05/02/2022
Date Signed: 05/02/2022 05:31:31 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
04/26/2022 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20220426122423

FACILITY NAME:	TOLUCA LAKE MANOR SENIOR ASSISTED LIVING LLC		FACILITY NUMBER:	197607575
ADMINISTRATOR:	MARIANA ROMANO		FACILITY TYPE:	740
ADDRESS:	4560 CARTWRIGHT AVE.		TELEPHONE:	(818) 232-7338
CITY:	TOLUCA LAKE	STATE: CA	ZIP CODE:	91602
CAPACITY:	6	CENSUS: 4	DATE:	05/02/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:			TIME COMPLETED:	10:36 AM

ALLEGATION(S):

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Facility is obstructing residents' and visitors' rights to contact the Ombudsman.

INVESTIGATION FINDINGS:

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On 05/02/2022, Licensing program Analyst Sandra Urena conducted an unannounced initial 10-day complaint investigation visit regarding the above allegation. LPA Urena arrived at the facility at 9:30 a.m., and was greeted by the staff. Staff stated that the administrator was not present, and would call the administrator. The LPA met with administrator Mariana Romano at 9:45 a.m., and explained the reason for the visit.

It is alleged that the ‘Facility is obstructing residents' and visitors' rights to contact the Ombudsman’. During an unannounced facility visit, it was observed that the Ombudsman poster was obstructed by various other postings such as cards, and papers. The concern is that the obstruction of the poster is preventing the residents' and visitors' right to contact the Ombudsman.

Continues on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

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-20220426122423

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: TOLUCA LAKE MANOR SENIOR ASSISTED LIVING LLC	FACILITY NUMBER: 197607575
	VISIT DATE: 05/02/2022

NARRATIVE

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At 9:50 a.m., LPA Urena and the administrator conducted a brief tour of the facility. During the tour, the LPA and the administrator observed that the Ombudsman poster was visibly displayed on a poster board located to the left of the entrance door. The LPA and the administrator observed other papers posted next to the Ombudsman poster.

At 9:55 a.m., the LPA interviewed the administrator about the visibility of the Ombudsman poster. The administrator stated that it was understood that the poster had to be in a visible place, and ensured that the poster was not obstructed at any time. At 9:40 a.m., the LPA interviewed the Staff#1(S1) about the visibility of the Ombudsman poster. The staff communicated that they have seen the poster in the same place, where it is today, and has not been moved or covered.

Based on today’s observation, and the information gathered for the above allegation, there is insufficient evidence to support the claim that the facility is obstructing the Ombudsman poster by placing cards, and papers over the poster. Therefore, although the allegation may have happened or is valid, there is insufficient evidence to confirm the obstruction of the poster, which may have prevented the residents’ and visitors’ right to contact the Ombudsman Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview was conducted with the administrator. No citations were issued. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

LIC9099 (FAS) - (06/04)

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