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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608309
Report Date: 02/04/2025
Date Signed: 02/04/2025 05:17:45 PM

Substantiated


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
01/30/2025 and conducted by Evaluator Christine Yee
COMPLAINT CONTROL NUMBER: 29-AS-20250130153145
FACILITY NAME:ETTA ISRAEL CENTER #4FACILITY NUMBER:
197608309
ADMINISTRATOR:HEIDI SCHOFIELDFACILITY TYPE:
735
ADDRESS:6101 BLUEBELLTELEPHONE:
(818) 980-1709
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 6DATE:
02/04/2025
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Heidi Schofield, AdministratorTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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1. Medications were unlocked making them accessible to residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and was let into the home by staff. Giovanna Montano, House Manager, was contacted and she arrived at 11:59am to start the visit. Heidi Schofield, Administrator arrived at 12:19pm to conduct the visit. The reason for today's visit was explained.

On today's visit, LPA Yee conducted an interview with Heidi Schofield and Giovanna Montano at 12:35pm and contacted the placement agency for clarification on the Corrective Action Plan that was generated on 12/16/24 and provided by the facility at 2:21pm. Copies of facility documents were also obtained during the visit.

Per information obtained from interviews conducted with the Administrator and House Manager, regarding
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
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 5
Control Number 29-AS-20250130153145
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: ETTA ISRAEL CENTER #4
FACILITY NUMBER: 197608309
VISIT DATE: 02/04/2025
NARRATIVE
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Page 2.

the allegation that Medications were unlocked making them accessible to residents in care, an unannounced inspection visit to the home was conducted by the placement agency on 12/16/24. During the inspection the lock on the refrigerator containing Resident #1's medications was inspected and the lock used to secure the refrigerator was pulled and it came unlocked, allowing the medications to become accessible to the residents in care. Based on the own admission of the facility staff and the observation of a credible source, the allegation that Medications were unlocked making them accessible to residents in care, is therefore substantiated.

Deficiency cited under California Code of Regulations, Title 22, Division 6, Chapter 1.

Exit interview was conducted, APPEALS RIGHTS discussed and a copy was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
01/30/2025 and conducted by Evaluator Christine Yee
COMPLAINT CONTROL NUMBER: 29-AS-20250130153145

FACILITY NAME:ETTA ISRAEL CENTER #4FACILITY NUMBER:
197608309
ADMINISTRATOR:HEIDI SCHOFIELDFACILITY TYPE:
735
ADDRESS:6101 BLUEBELLTELEPHONE:
(818) 980-1709
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 6DATE:
02/04/2025
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Heidi Schofield, AdministratorTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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2. Staff did not dispose of expired medications properly
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and was let into the home by staff. Giovanna Montano, House Manager, was contacted and she arrived at 11:59am to start the visit. Heidi Schofield, Administrator arrived at 12:19pm to conduct the visit. The reason for today's visit was explained.

On today's visit, LPA Yee conducted an interview with Heidi Schofield and Giovanna Montano at 12:35pm and contacted the placement agency for clarification on the Corrective Action Plan that was generated on 12/16/24 and provided by the facility at 2:21pm. Copies of facility documents were also obtained during the visit.

Upon review of the medications stored in the refrigerator, it was observed that the Lisinopril had expired on November 2024 and the Sirolimus had been discontinued in February 2024 and both medications had
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250130153145
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: ETTA ISRAEL CENTER #4
FACILITY NUMBER: 197608309
VISIT DATE: 02/04/2025
NARRATIVE
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not been returned to the pharmacy for destruction. The explanation provided by the staff for the retention of the expired Lisinopril was that they were waiting for the pharmacy to pick up the medication that had recently expired and the Sirolimus was retained as advised by the physician, just in case it was needed and in the event that the insurance would not cover the cost of a new supply. However, the facility did not obtain a physician's note confirming those instructions. Since the placement agency's visit on 12/16/24, both medications were returned to the prescribing hospital on 12/17/24. Per review of Title 22 and the facility's Plan of Operation, discontinued medications should be returned to the pharmacy, but it does not specify how soon expired and discontinued medications have to be returned for destruction as long as the expired and discontinued medications are made inaccessible to the residents in care.

Based on the information obtained, there is insufficient evidence to support the allegation that Staff did not dispose of expired medications properly, therefore the allegation is unsubstantiated at this time.


Exit interview was conducted.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250130153145
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: ETTA ISRAEL CENTER #4
FACILITY NUMBER: 197608309
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/05/2025
Section Cited
CCR
80075(K)(1)
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HEALTH RELATED SERVICES: The following requirements shall apply to medications which are centrally stored:
Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the
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The Licensee will ensure that all centrally stored medications are kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medications. Licensee will also ensure that the lock securing the medications are
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supervision of the centrally stored medication.
Per visit conducted by the placement agency on 12/16/24 and the admission of the staff of that visit, the refrigerator lock was tested and it came open when it was pulled during the visit, allowing the medications to be accessible to the residents in care.
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well maintained and replaced immediately when the lock is observed to be defective or observed to be not in good condition.
****the medication cabinet was pulled and shaken during this visit and was observed to be secure and the medications were inaccessible*****
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5