197608466-6-30-2025-29-AS-KHEN-DJ62F8-20250630172108

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608466
Report Date: 06/30/2025
Date Signed: 06/30/2025 11:25:01 AM

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
05/09/2024 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20240509082740

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: 109	DATE:	06/30/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Abigail Traxler, Courtney Barber		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff pushed resident.
Staff are violating resident’s personal rights.
Staff threatened resident.
Water temperature not within required range.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced subsequent complaint visit to this facility. At 8:30 a.m., the LPA met with staff and explained the reason for the visit. At 9:17 a.m., the
Executive Director (ED) Abigail Traxler arrived at the facility. At 10:50 a.m., the LPA met with Director of Resident Care Services (DRCS), Courtney Barber.

During the initial visit on 5/16/2024, between 9:28 a.m. and 12:30 p.m., the LPA conducted a brief physical plant tour and interviews with five (5) staff and five (5) residents. During today’s visit, between 9:30 a.m. and 10:37 a.m., the LPA conducted a physical plant tour, an interview with the ED and Staff #1 (S1). During both visits, the LPA requested and obtained copies of pertinent documents.

Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

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-20240509082740

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: 06/30/2025

NARRATIVE

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Regarding the allegations: 1.) Staff pushed resident. 2.) Staff are violating resident’s personal rights. 3.) Staff threatened resident. 4.) Water temperature not within required range. On 05/09/2024, the Department received a complaint alleging Staff #1 (S1) and Staff #2 (S2) forcing Resident #1 (R1) into taking a shower in which the water was inconsistent going from scolding hot to ice cold. It was alleged that S1 and S2 threaten R1 and pushed R1 causing R1 to fall. During the initial visit, interview with R1 revealed little to no information regarding the allegations. R1 did not comment on the allegations and stated that there are no concerns regarding staff. R1 did state that R1 can control the shower’s temperature however that the shower controls can be difficult to navigate. Interview with ED conducted on 06/30/2025, revealed that R1 is no longer at the facility. The ED revealed that during the time of the alleged incident, the facility conducted an internal investigation in which both S1 and S2 denied the allegations. The ED stated that after their internal investigation, S1 and S2 were reassigned to work on different floors. The LPA conducted an interview with S1 during today’s visit; S1 denied the allegations. Residents interviewed did not voice any concerns regarding staff. Staff interviews revealed that they have not observed or heard of staff pushing residents or threatening residents. During the initial and subsequent visit, the LPA tested the water temperature throughout the building and found the water temperature to be within required range. The information obtained during the investigation did not include evidence sufficient to corroborate the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed Unsubstantiated at this time.

Exit interview conducted with Courtney Barber. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

LIC9099 (FAS) - (06/04)

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