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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608694
Report Date: 07/23/2026
Date Signed: 07/23/2026 04:11:29 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
02/04/2026 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20260204150834
FACILITY NAME:VILLAGE AT SHERMAN OAKS, THEFACILITY NUMBER:
197608694
ADMINISTRATOR:GRACE HARTNETTFACILITY TYPE:
740
ADDRESS:5450 VESPER AVETELEPHONE:
(818) 994-7900
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91411
CAPACITY:179CENSUS: 146DATE:
07/23/2026
UNANNOUNCEDTIME BEGAN:
01:44 PM
MET WITH:Justine OrtizTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff charges resident for services not rendered
Staff don't respond to resident in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted a follow-up complaint visit for the above allegations. LPA arrived to the facility at 01:44 PM. LPA met with Interim Executive Director Justine Ortiz (ED-I). Entrance interview conducted and the reason for the visit was explained.

During today’s visit, the LPA interviewed the ED-I and delivered findings between approximately 01:46 PM and 03:45 PM.

CONTINUED ON LIC 9099C.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2026
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 6
Control Number 29-AS-20260204150834
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: VILLAGE AT SHERMAN OAKS, THE
FACILITY NUMBER: 197608694
VISIT DATE: 07/23/2026
NARRATIVE
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The allegation of “Staff don't respond to resident in a timely manner.” Alleges that facility staff did not clean R1’s room, do R1’s laundry, or take R1’s food orders in a timely manner. LPA interviewed R1 who stated that due to their health conditions they required food to be delivered at specific times during the day. R1 stated that when they originally began tray service they would place their food orders for the kitchen by writing down their requests on the daily menu which a caregiver would deliver to the kitchen to prepare. R1 stated that this led to delays in receiving their food in a timely manner so they were instructed to call in their order to the front desk. R1 stated that on multiple occasions food was not delivered or was left outside of their door without any notification that the food had arrived. LPA interviewed the Director of Dining (DD) who confirmed that the facility had requested R1 to call the front desk to place orders for delivery. DD stated that they expect R1’s call at certain times during the day and if they did not hear from R1 they would personally call to take R1’s order. Regarding the laundry service at the facility LPA interviewed R1 who stated that they were supposed to receive laundry assistance once per week but laundry was often completed late or missed by staff. LPA requested monthly task logs for laundry assistance provided to R1 between January - March of 2025. LPA reviewed the logs that the facility had submitted and observed that between 01/15/2025 and 03/14/2025 all Fridays showed laundry assistance as “Task Not Completed” (TNC). LPA interviewed ED-I who informed LPA that the facility had swapped to a different record keeping system around that time and any logs prior to the implementation of that system would show as “TNC”. The ED-I informed LPA that they were unable to pull any previous records for laundry assistance as those records are only retained for one (1) year. Regarding R1’s room not being cleaned in a timely manner, LPA interviewed R1 who stated that facility staff often did not make their bed or take out the trash from their room in a timely manner. LPA observed R1’s room on 02/09/2026 and observed two (2) trash cans which were full, multiple used towels on the floor of the bathroom, and trash on the sink counter. LPA reviewed evidence submitted and observed notes which indicated that R1 did not receive assistance with taking out the trash or making the bed on 02/08/2026, 02/02/2026, 01/29/2026, 01/22/2026, 01/17/2026, and 01/15/2026. Ten (10) additional dates were observed between 12/16/2026 - 02/08/2026 where assistance with either taking out the trash or making the bed was not provided. Based on the information obtained during observation, record review, and interviews there is sufficient evidence to support the allegation of “Staff don't respond to resident in a timely manner.” Therefore, the allegation is deemed Substantiated at this time.

The following deficiencies were cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20260204150834
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: VILLAGE AT SHERMAN OAKS, THE
FACILITY NUMBER: 197608694
VISIT DATE: 07/23/2026
NARRATIVE
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The allegation of “Staff charges resident for services not rendered.” Alleges that the facility had charged Resident #1 (R1) for services including standby shower assistance and tray delivery service when the services had not been provided. LPA interviewed R1 who stated that they had signed up for standby shower assistance however, when receiving assistance, the staff member who was supposed to be standing by to provide assistance was often performing other tasks around the apartment such as making the bed, taking out the trash, or utilizing their phone. Additionally, R1 stated that when receiving tray delivery service, they would often have to send food back due to the food arriving cold or not cooked to their liking. R1 stated that they would be charged for a second tray delivery when this occurred. LPA reviewed R1’s “Resident Detail Ledger” which outlined the charges R1 accrued at the facility. LPA observed multiple dates where R1 was charged more than three (3) times per day for tray delivery service. LPA interviewed Witness #1 (W1), who stated that R1 was compensated by the Executive Director (ED) when food was sent back to the kitchen and a new meal had to be delivered. LPA reviewed R1’s resident file and observed that on 01/09/2025 R1 was assessed by the facility as needing standby shower assistance seven (7) days per week. LPA observed that as a result of this assessment R1 was identified as requiring level two (2) assistance. LPA observed that R1 ceased standby shower assistance on 03/14/2025. LPA interviewed facility staff and ED who confirmed that when performing standby shower assistance staff are expected to be next to the shower and not performing other tasks around the apartment. LPA requested monthly task logs for shower assistance provided to R1 between January - March of 2025. LPA reviewed the logs that the facility had submitted and observed that between 01/15/2025 and 03/14/2025 only one (1) day was marked as completed, one (1) day was marked as a refusal, and on six (6) days the service was paused. The remainder of the days showed the standby assistance as “Task Not Completed” (TNC). LPA interviewed ED-I who informed LPA that the facility had swapped to a different record keeping system around that time and any logs prior to the implementation of that system would show as “TNC”. The ED-I informed LPA that they were unable to pull any previous records for standby shower assistance as those records are only retained for one (1) year. LPA reviewed evidence submitted and observed notes which indicated that R1 did not receive standby shower assistance on fifteen (15) days between 02/08/2025 and 03/03/2025. Based on the information obtained during interviews and record review there is sufficient evidence to support the allegation of “Staff charges resident for services not rendered.” Therefore, the allegation is deemed Substantiated at this time.

CONTINUED ON LIC 9099C.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 29-AS-20260204150834
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: VILLAGE AT SHERMAN OAKS, THE
FACILITY NUMBER: 197608694
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2026
Section Cited
CCR
87507(f)
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87507 Admission Agreements
(f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments.
This requirement is not met as evidenced by:
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ED-I agreed to conduct an in-service training with all facility staff who provide shower assistance to assisted living residents to discuss the expectations of the facility when providing this service. Additionally, ED-I agreed to submit a statement of...
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Based on interview and record review the licensee did not comply with the section cited above as R1 was charged for tray delivery service and standby shower assistance when the services were not provided to R1 which posed a potential personal rights risk to clients in care.
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understanding confirming that the facility will comply with all agreed upon services laid out in the admission agreement and resident appraisal. ED-I agreed to submit proof of the completed training and the statement to CCLD no later than POC due date.
Type B
08/06/2026
Section Cited
CCR
87464(f)(1)
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(f) Basic services shall at a minimum include:
(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).
This requirement is not met as evidenced by:
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ED-I agreed to conduct an in-service training with caregivers, servers, and housekeeping staff on the importance of ensuring that resident's needs are met in a timely manner and on the importance of accurately logging resident's refusals of services. ED-I agreed to submit proof of the completed training to...
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Based on observation, interview, and record review the licensee did not comply with the section cited above as R1's room was not cleaned, laundry was not done, and food was not delivered on time which posed a potential personal rights risk to clients in care.
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CCLD no later than POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 29-AS-20260204150834
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: VILLAGE AT SHERMAN OAKS, THE
FACILITY NUMBER: 197608694
VISIT DATE: 07/23/2026
NARRATIVE
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The allegation of “Staff are not practicing proper hand hygiene techniques” alleges that facility staff are not following proper hand hygiene and infection control practices when assisting facility residents. LPA interviewed R1 who stated that facility staff who were assisting them in their apartment would either not change their gloves between taking out the trash, making the bed, and assisting R1 or would not wear gloves at all when performing these tasks. LPA interviewed facility residents who stated that they always observe facility staff wearing gloves when providing assistance. LPA interviewed facility staff members who were able to appropriately identify the facility’s hand hygiene techniques and standard operating procedures. Staff members interviewed were able to appropriately identify the requirements of washing hands prior to assisting residents, changing gloves between assisting residents or performing other tasks in the apartments, and washing hands after finishing with assistance. LPA reviewed the facility’s infection control plan and observed adequate hand hygiene procedures outlined in the plan. LPA interviewed the ED-I who stated that trainings regarding infection control and hand hygiene procedures are performed every other month and the expectations are reviewed with each employee during shift crossovers. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff are not practicing proper hand hygiene techniques.” Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of the report was issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
02/04/2026 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20260204150834

FACILITY NAME:VILLAGE AT SHERMAN OAKS, THEFACILITY NUMBER:
197608694
ADMINISTRATOR:GRACE HARTNETTFACILITY TYPE:
740
ADDRESS:5450 VESPER AVETELEPHONE:
(818) 994-7900
CITY:SHERMAN OAKSSTATE:CAZIP CODE:
91411
CAPACITY:179CENSUS: 146DATE:
07/23/2026
UNANNOUNCEDTIME BEGAN:
01:44 PM
MET WITH:Justine OrtizTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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2
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Staff are not practicing proper hand hygiene techniques
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted a follow-up complaint visit for the above allegations. LPA arrived to the facility at 01:44 PM. LPA met with Interim Executive Director Justine Ortiz (ED-I). Entrance interview conducted and the reason for the visit was explained.

During today’s visit, the LPA interviewed the ED-I and delivered findings between approximately 01:46 PM and 03:45 PM.

CONTINUED ON LIC 9099C.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6