197608466-1-14-2026-29-AS-KHEN-DQRMQD-20260128084831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608466
Report Date: 01/14/2026
Date Signed: 01/14/2026 02:46:39 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
12/23/2025 and conducted by Evaluator Quoc Huynh

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20251223144304

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:	01/14/2026
		UNANNOUNCED	TIME BEGAN:	10:36 AM
MET WITH:	Kate Blackman - Memory Care Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not ensure resident's hygiene needs were being met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Quoc Huynh conducted a subseuqent complaint visit to deliver findings for the above allegation. The LPA arrived at 10:36AM and met with Memory Care Unit (MCU) Director Kate Blackman. Entrance interview conducted.

On 12/29/2025, the LPA conducted an initial visit. Between 9:33AM and 11:45AM, the LPA conducted a physical plant tour, interviewed the Executive Director and MCU Director, interviewed two (2) staff, and reviewed and obtained pertinent documents.

During today’s visit between 10:44AM and 2:02PM, the LPA conducted a physical plant tour and interviewed five (5) residents and three (3) staff. No immediate concerns were observed. The following was then determined:

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

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-20251223144304

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: 01/14/2026

NARRATIVE

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Allegation: “Staff did not ensure resident's hygiene needs were being met”

It was reported that resident hygiene needs such as washing hands were not maintained which resulted in Resident #1 (R1) contracting Clostridioides Difficile (C. Diff). Interview with residents revealed no overall concerns about the facility’s cleaning protocols. Residents stated they frequently observe staff cleaning/sanitizing their rooms in addition to common areas. Residents also had no concerns regarding their hygiene needs and expressed that they always feel clean. Residents reported washing their hands as frequently as they can with staff assistance.

Staff reported that residents with illnesses or contagious diseases are kept in isolation in their rooms or sent to the hospital. During this time, personal protective equipment (PPE) is provided outside the rooms for staff utilization when providing care. As an extra precaution, typically one (1) staff is assigned to that resident’s care to prevent further contamination. Residents who are symptom free and cleared of their illness will then return to the community and staff then clean the infected rooms which include laundry services and sanitizing/disinfecting all surfaces. During day-to-day operations, the facility’s common areas are cleaned frequently with staff access to cleaning chemicals if needed. Housekeepers and the maintenance team provide deep cleanings during the overnight shifts. Staff reported hand sanitizing stations throughout the facility for everyone to use in addition to following hand washing and glove precautions. Specifically, the MCU utilizes hand wipes before meals to accommodate resident preferences.

Record review revealed that R1 experienced a change of condition on 08/29/2024 and was subsequently transferred to the hospital. On 08/31/2024, R1 returned to the facility with an eye infection and was prescribed antibiotics. R1 later tested positive for C. Diff on 09/02/2024, was sent to the hospital, and returned to the facility on 09/17/2024 with negative results. On 10/01/2024, R1 showed symptoms of C. Diff, was transferred to the hospital, and returned to the facility on 10/11/2024. Medication review revealed that R1 was not prescribed antibiotics in August 2024; however, in September 2024 R1 took three (3) antibiotics and two (2) antibiotics in October 2024.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20251223144304

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: 01/14/2026

NARRATIVE

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It was also revealed that Resident #2 (R2) had C. Diff in March 2024 and was sent to the hospital until asymptomatic and returned to the facility and has not had C. Diff since. Furthermore, R1 moved to the MCU from Assisted Living in December 2023, and R2 moved to the MCU from Assisted Living on 02/19/2025. Although it was possible both residents may have been in contact at community events, R1 and R2 were not in contact while actively diagnosed with C. Diff.

Per information released by the U. S. Centers for Disease Control and Prevention (CDC) on 12/18/2024, C. Diff is common among individuals in healthcare settings such as hospitals and nursing homes. It is spread from person to person through feces and inactive spores in the environment that can be activated by swallowing the spores. The CDC reported C. Diff infections can also occur when taking antibiotics which result in C. Diff side effects. It was recommended to reduce the spread by washing hands with soap and water after restroom use and before meals.

Based on interviews and record review, the facility followed infection control procedures and ensured residents’ hygiene were maintained. Additionally, R1 visited the hospital and was prescribed antibiotics shortly before contracting C. Diff, which may have increased their risk of exposure. Although R1 did contract C. Diff, there is not sufficient evidence to prove the alleged violation was a result of resident hygiene needs being unmet, therefore the allegation is deemed UNSUBSTANTIATED at this time.

No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC9099 (FAS) - (06/04)

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