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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608603
Report Date: 05/28/2024
Date Signed: 05/28/2024 04:06:38 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
03/10/2022 and conducted by Evaluator Emily Peraldi
COMPLAINT CONTROL NUMBER: 29-AS-20220310124420
FACILITY NAME:LIVEWELL RESIDENTIAL CARE HOMEFACILITY NUMBER:
197608603
ADMINISTRATOR:FRANCIS MARTIRFACILITY TYPE:
740
ADDRESS:14315 VALERIO STREETTELEPHONE:
(818) 989-1073
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:0CENSUS: 0DATE:
05/28/2024
UNANNOUNCEDTIME BEGAN:
03:47 PM
MET WITH:Flory MoralesTIME COMPLETED:
03:56 PM
ALLEGATION(S):
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Medications are not being self administered as prescribed
Medication records are not being documented correctly
Resident is not being provided assistance with transportation
Residents are not receiving appropriate care
Unlawful Eviction
Staff is retaliating against resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced telephonic subsequent complaint visit at the facility today to deliver findings. At 3:47 p.m., LPA Peraldi called the Licensee Flory Morales and explained the reason for the phone call.

During the initial visit on 3/17/2022, between 10:45 a.m. and 4:00 p.m., LPA Saila Walker conducted a facility tour and reviewed records and obtained copies of pertinent documents. The LPA also conducted interviews with the Administrator, two (2) residents and two (2) staff.

Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
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 2
Control Number 29-AS-20220310124420
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: LIVEWELL RESIDENTIAL CARE HOME
FACILITY NUMBER: 197608603
VISIT DATE: 05/28/2024
NARRATIVE
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Regarding the allegations: Medications are not being self-administered as prescribed. Medication records are not being documented correctly. The Complainant indicated that facility staff did not assistance with medications as prescribed or did not log medications properly. The information obtained during the investigation included copies of the Medication and Administration Record (MAR) for two (2) residents. Interview with Resident #1 (R1) did not reveal any concerns with medication management. 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.

Regarding the allegations: Resident is not being provided assistance with transportation. Residents are not receiving appropriate care. Staff is retaliating against resident. The Complainant indicated that facility staff did not properly care of the residents in care. No additional information was given. Interviews available did not provide additional evidence or information. 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.

Regarding the allegations: Unlawful Eviction. The Complainant indicated that an outside individual, not facility staff threatened an eviction to Resident #2 (R2). Interviews available did not provide additional evidence or information. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was issued to the former licensee via mail for signature.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
LIC9099 (FAS) - (06/04)
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