197608466-2-25-2025-29-AS-KHEN-DEC7VD-20250228205947

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608466
Report Date: 02/25/2025
Date Signed: 02/25/2025 01:50:58 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
04/17/2024 and conducted by Evaluator Angela Barutyan

COMPLAINT CONTROL NUMBER: 29-AS-20240417163437

FACILITY NAME:	BELMONT VILLAGE ENCINO		FACILITY NUMBER:	197608466
ADMINISTRATOR:	ABIGAIL TRAXLER		FACILITY TYPE:	740
ADDRESS:	15451 VENTURA BLVD		TELEPHONE:	(818) 788-8870
CITY:	SHERMAN OAKS	STATE: CA	ZIP CODE:	91403
CAPACITY:	150	CENSUS: 101	DATE:	02/25/2025
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Abigail Traxler		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Unlawful eviction
Facility staff financially abused resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation at 10:50AM. LPA met with Executive Director (ED) Abigail Traxler. Reason for the visit was explained.

During today’s visit, LPA Barutyan conducted interviews with two (2) residents and ED Traxler and reviewed and obtained copies of pertinent documents. During the initial visit on 04/23/2024 beginning at 09:25AM, LPA E. Peraldi conducted an interview with ED Traxler, obtained copies of pertinent documents, conducted an interview with one (1) staff, and conducted a physical plant tour with the ED.

CONTINUED ON LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angela Barutyan	TELEPHONE: 747-922-1234
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

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-20240417163437

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: BELMONT VILLAGE ENCINO	FACILITY NUMBER: 197608466
	VISIT DATE: 02/25/2025

NARRATIVE

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Report Continued from LIC 9099. It was alleged that previous ED Ralph Balbin issued an eviction to Resident #1 (R1) without proper 30-days’ notice. Interviews with ED, responsible party of R1, and staff revealed that it was determined R1 had a change of condition requiring the resident to be placed in memory care to meet higher care needs. Facility management verbally informed R1 and responsible party of R1 on approximately 11/15/2022 that R1 will need to move to the memory care unit by 12/01/2022 or the facility will move forward with eviction proceedings on the basis that the facility is unable to meet the care needs of R1. Facility was notified by R1’s responsible party on 11/30/2022 that R1 will move out of the facility. R1 voluntarily moved out of the facility on 12/03/2022. No eviction notice was issued to R1 by the facility and no eviction notice was received by the Department for R1. Furthermore, R1’s admission agreement signed and dated on 12/30/2017 states the facility “upon thirty (30) day’s notice” may terminate the agreement if the facility “and the person who performs the reappraisal believe that the Community is no longer appropriate for [the resident]” and for “failure to comply with the general policies of the Community” which include possible termination if the resident/responsible party of resident “refuse to accept services required in order for [the facility] to meet [the resident’s] needs.” R1’s long-term physician confirmed R1’s change of condition in a signed letter dated 05/10/2022 stating that R1 “is dependent in in [their] basic and instrumental activities of daily living” (ADLs) and “is at risk for wandering and requires substantial supervision.” However, on 12/01/2022, R1 received a second opinion from their primary care provider who stated that they “support the decision of not moving the patient to Memory Unit at this time, given [the patient’s] current cognitive functional level.” On 11/26/2022, R1’s long-term psychologist also recommended that R1 “not go into Memory Care at Belmont Encino because it will be overly restrictive and insufficiently stimulating.” However, as no eviction notice was issued by the facility, the services required for the facility to meet R1’s care needs were refused, and a proper 30-day notice of moving was not provided, the information obtained through interview and record review for this investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation “Unlawful eviction” is deemed UNSUBSTANTIATED at this time.

It was further alleged that facility staff financially abused R1 by overcharging for unused services and rent. LPA reviewed R1’s ledger from 01/01/2022 - 12/31/2023 and observed a monthly rent charge of $11,575.00 automatically charged to the card on file every 1^st day of the month and extra services charged every 15^th day of the month.

Report Continued on LIC 9099-C.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angela Barutyan	TELEPHONE: 747-922-1234
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240417163437

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: BELMONT VILLAGE ENCINO	FACILITY NUMBER: 197608466
	VISIT DATE: 02/25/2025

NARRATIVE

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Report Continued from LIC 9099-C.

Additional charges were observed for services such as outings, haircuts, and escorts. R1 was charged $11,575.00 monthly rent on 12/01/2022 and was incorrectly automatically charged $129.56 on 12/15/2022 for multiple outings and an escort after moving; $17.93 outing, $41.63 outing, and $70 escort. R1’s ledger from 01/01/2023 documents that the extra services of $129.56 automatically charged after R1 moved out of the facility were returned to the account. A total of $11,829.56 ($129.56 of extra services not used + $125.00 recurring total incontinence management supplies (TIMs) fee automatically charged on 01/01/2023 + $11,575.00 monthly fee automatically charged on 01/01/2023) was returned to the account on 01/05/2023. On 01/15/2023, R1’s account was then credited a total of $10,770.41 ($115.07 TIMs fee + 10,655.34 monthly fee) for the period of 01/04/2023 – 01/31/2023, making the total balance $1,059.15 ($11,829.56 - 10,770.41). R1’s admission agreement signed and dated on 12/30/2017 states under “termination by resident” that a resident “may terminate this Agreement at any time, with or without cause, by giving the Executive Director thirty (30) days’ prior written notice of termination” and the resident “will continue to be responsible for [their] full Monthly Fee until the thirty (30) day period has expired.” The facility was notified by R1’s responsible party on 11/30/2022 that R1 will move out of the facility, meaning that the thirty (30) day period would be from 11/30/2022 – 12/30/2022. R1 moved out of the facility on 12/03/2022. R1 was charged for the period of 12/03/2022 – 01/03/2023, totaling $1,059.15 after accounting for the full December 2022 rent of $11,575.00 and $125.00 recurring TIMs fee charged on 12/01/2022. Therefore, the remaining balance of $1,059.15 ($9.93 recurring TIMs fee + $919.66 monthly rent) is for the three (3) additional days in January 2023 counting for thirty (30) days after R1 moving, 12/03/2022. However, R1 moved out within the thirty (30) day notice was that was received by the facility on 11/30/2022. The facility dropped the balance of $1,059.15 on 04/30/2024. The information obtained for this investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation “Facility staff financially abused resident” is deemed UNSUBSTANTIATED at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angela Barutyan	TELEPHONE: 747-922-1234
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

LIC9099 (FAS) - (06/04)

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