197609061-8-5-2020-31-AS-MVAO-BS8PRW-20200806113326

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609061
Report Date: 08/05/2020
Date Signed: 08/05/2020 03:27:35 PM

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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/08/2020 and conducted by Evaluator Desaree Perera

COMPLAINT CONTROL NUMBER: 31-AS-20200408163152

FACILITY NAME:	WEST VALLEY ASSISTED LIVING		FACILITY NUMBER:	197609061
ADMINISTRATOR:	SAENZ, AMANDA		FACILITY TYPE:	740
ADDRESS:	7055 SHOUP AVENUE		TELEPHONE:	(818) 883-7201
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	90	CENSUS: 51	DATE:	08/05/2020
		UNANNOUNCED	TIME BEGAN:	02:49 PM
MET WITH:	Jonathan Millian		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Food Services is inadequate.
Facility staff is rude, harsh, and condescending

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Desaree Perera initiated a subsequent complaint to the above facility. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Jonathan Millian at 2:53pm. The purpose of the telephonic visit is to conclude an investigation initiated by LPA on 04/20/2020.

It was alleged the facility food service was not adequate and that the facility did not serve a nutritious meal to residents, especially during dinner. During the course of the investigation, the LPA conducted interviews with facility staff on 04/20/20 at 8:59am, 07/23/20 between 9:59am at 12:00pm, and 07/28/2020 at 8:53am and 10:33am. Furthermore, the LPA interviewed random sample of facility residents, responsible parties on 04/10/20 at 10:05am and 07/28/2020 between 9:45am and 1:33pm.

Continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-343
LICENSING EVALUATOR NAME: Desaree Perera	TELEPHONE: (747) 230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2020

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-20200408163152

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WEST VALLEY ASSISTED LIVING	FACILITY NUMBER: 197609061
	VISIT DATE: 08/05/2020

NARRATIVE

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Documentation pertinent to the allegation was also requested and reviewed by LPA on 07/23/20 at 8:30am and 11:15am, 07/27 at 3:00pm, and 07/28/2020 between 7:15am and 10:00am. Based on information gathered, it has been determined that the Department does not have sufficient information to determine the food services is inadequate; therefore, the allegation is deemed UNSUBSTANTIATED at this time.

It was already reported the manager/administrator of the facility is rush, harsh, and condescending. During the course of the investigation, the LPA conducted interviews with facility staff on 04/20/20 at 8:59am, 07/23/20 between 9:59am at 12:00pm, and 07/28/2020 at 8:53am and 10:33am. Furthermore, the LPA interviewed random sample of facility residents, responsible parties on 04/10/20 at 10:05am and 07/28/2020 between 9:45am and 1:33pm. Based on information gathered, it has been determined that the Department does not have sufficient information to determine the facility administrator is rude and condescending; therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Violations that were discovered during the course of the investigation that are unrelated to the complaint will be addressed on a separate Case Management visit at a later time.

Exit Interview Conducted / A copy of report was sent via email for signature.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-343
LICENSING EVALUATOR NAME: Desaree Perera	TELEPHONE: (747) 230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2020

LIC9099 (FAS) - (06/04)

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