197609049-10-12-2023-31-AS-NMAN-CZ6SVL-20240104131256

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609049
Report Date: 10/12/2023
Date Signed: 10/12/2023 04:29:00 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/30/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230130094323

FACILITY NAME:	FALLBROOK GLEN OF WEST HILLS		FACILITY NUMBER:	197609049
ADMINISTRATOR:	LILIT CHAPARYAN		FACILITY TYPE:	740
ADDRESS:	6833 FALLBROOK AVE		TELEPHONE:	(818) 883-4123
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	114	CENSUS: 45	DATE:	10/12/2023
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Stephanie Oden		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Residents are not provided proper food service

INVESTIGATION FINDINGS:

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At 12:40 p.m. on 10/12/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with the Administrator and disclosed the reason for the visit.

To investigate the allegation above, LPA conducted an initial complaint visit on 02/08/2023. LPA conducted a subsequent visit on 09/20/2023 and interviewed 10% of residents and staff between 12:00 p.m. and 2:30 p.m. and between 11:15 a.m. and 2:00 p.m. on 10/09/2023. LPA reviewed records at 11:45 a.m. on 09/20/2023 and toured the facility at 12:00 p.m. on 10/09/2023.

Regarding the allegation “Residents are not provided proper food service” it was alleged the facility did not offer an adequate variety of food. Interviews with residents at 1:35 p.m. and 1:55 p.m. on 09/20/2023 and at 12:00 p.m., 12:30 p.m., and 1:00 p.m. on 10/09/2023 revealed the variety and quality of food served meets the residents’ needs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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 31-AS-20230130094323

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: FALLBROOK GLEN OF WEST HILLS	FACILITY NUMBER: 197609049
	VISIT DATE: 10/12/2023

NARRATIVE

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Interviews with Staff #1 (S1) and Staff #2 (S2) at 11:15 a.m. and 1:30 p.m. on 10/09/2023 revealed all residents can choose from the main menu or alternate menu and staff accommodate resident needs. The same food is served to residents in the Memory Care and the Assisted Living sections of the facility. S1 stated they communicate with S2 about resident requests for any alternative requests. Record review at 11:45 a.m. on 09/20/2023 revealed the facility posted a daily and weekly menu with adequate variety of food. LPA observed food service between 12:00 p.m. and 1:00 p.m. on 10/09/2023. LPA observed an adequate variety of food, as well as residents requesting additional food and receiving special orders. Based on interviews and observations, there is insufficient evidence to verify the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC9099 (FAS) - (06/04)

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