197608694-5-2-2023-29-AS-DPEA-CS3UUF-20230522155330

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608694
Report Date: 05/02/2023
Date Signed: 05/02/2023 01:34:48 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/26/2023 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20230426171159

FACILITY NAME:	VILLAGE AT SHERMAN OAKS, THE		FACILITY NUMBER:	197608694
ADMINISTRATOR:	DANA ANDERSON		FACILITY TYPE:	740
ADDRESS:	5450 VESPER AVE		TELEPHONE:	(818) 994-7900
CITY:	SHERMAN OAKS	STATE: CA	ZIP CODE:	91411
CAPACITY:	179	CENSUS: 141	DATE:	05/02/2023
		UNANNOUNCED	TIME BEGAN:	11:44 AM
MET WITH:	Keith Payne, Administrator		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility did not notify resident of rate increases prior to residents admission.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi, conducted an unannounced 10-day initial complaint visit to this facility. At 11:44 a.m., the LPA met with staff and explained the reason for the visit. At 11:52 a.m., the LPA met with the Administrator, Keith Payne.

At 11:57 a.m., the LPA conducted an interview with the Administrator. Between 12:08 p.m. and 12:21 p.m., the LPA along with the Administrator, conducted a brief physical plant tour. Between 12:08 p.m. and 12:16 p.m., the LPA interviewed five (5) out of one hundred forty-one (141) residents. At 12:22 p.m., the LPA reviewed records and obtained copies of pertinent documents.

Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023

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-20230426171159

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VILLAGE AT SHERMAN OAKS, THE	FACILITY NUMBER: 197608694
	VISIT DATE: 05/02/2023

NARRATIVE

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Regarding the allegation: Facility did not notify resident of rate increases prior to resident’s admission. On 04/26/2023, the Department received a complaint in which it was alleged that the facility did not properly notify the resident’s representative with the possibility of a rate increase prior to the resident’s admission. Interview conducted with the Administrator at 11:57 a.m., revealed that the adjustment or increase of fees and rate is disclosed in the facility’s Admission Agreement. Additionally, the Administrator stated that The Village at Sherman Oaks provides a Rate Increase Disclosure Form from the past three (3) years to prospective residents prior to admission. The Rate Increase Disclosure Form provides data on actual past rate increases for residents. The Administrator explained that prior to admission, the facility sends out a copy of a welcome package, which includes the Admission Agreement and the Rate Increase Disclosure Form, to the prospective resident or resident’s representative so that it could be reviewed prior to meeting with the Administrator in person. At 12:22 p.m., the LPA reviewed the Admission Agreement for both the assisted living and memory care unit and The Rate Increase Disclosure Form. The LPA confirmed that the Admission Agreement for both the assisted living and memory care unit included a section regarding rate or rate structure change/ adjustment to fees. Furthermore, the facility’s Admission Agreement, under the section of “Adjustments to Fees” did explain that the facility will provide a written notice to the resident 60 days prior to any rate or rate structure change. 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 Unsubstantiated.

Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023

LIC9099 (FAS) - (06/04)

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