197609049-12-6-2023-31-AS-NMAN-CZEQF3-20240112110717

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609049
Report Date: 12/06/2023
Date Signed: 12/06/2023 09:40:14 AM

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
10/20/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20231020085843

FACILITY NAME:	FALLBROOK GLEN OF WEST HILLS		FACILITY NUMBER:	197609049
ADMINISTRATOR:	STEPHANIE ODEN		FACILITY TYPE:	740
ADDRESS:	6833 FALLBROOK AVE		TELEPHONE:	(818) 883-4123
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	114	CENSUS: 41	DATE:	12/06/2023
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Stephanie Oden		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Staff do not ensure that residents' dietary needs are met

INVESTIGATION FINDINGS:

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At 8:20 a.m. on 12/06/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with the Administrator and disclosed the reason for the visit.

Regarding the allegation “Staff do not ensure that residents' dietary needs are met” it was alleged that food is served cold and the facility is running out of food. Additionally residents’ specific diets are not posted in the kitchen. To investigate this allegation, LPA conducted an initial visit at 8:30 a.m. on 10/24/2023 and interviewed four (04) staff members between 8:50 a.m. and 9:30 a.m. and toured the facility and the kitchen at 9:15 a.m. During today’s visit, LPA interviewed five (05) out of forty-three (43) residents between 8:30 a.m. and 9:15 a.m. and toured the facility at 8:30 a.m.

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: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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-20231020085843

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: 12/06/2023

NARRATIVE

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Resident interviews revealed five (05) out of five (05) residents felt their dietary needs were met in terms of food temperature and quantity. Staff interviews on 10/24/2023 revealed the facility uses heated dishes, heat lamps, and prepares food to adequate temperatures. Staff follow resident dietary needs when preparing meals. During the kitchen tour at 9:15 a.m. on 10/24/2023, LPA observed forty-three (43) resident cards posted in the kitchen with dietary needs included. LPA also observed heat lamps, heated dishes, and adequate supplies of perishable and non-perishable foods in the refrigerators and freezers. Based on interviews and observations, the facility is meeting residents’ dietary needs. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety hazards were observed during this visit.

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: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

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