197609061-11-11-2020-31-AS-CHAS-BX3RP4-20210108121120

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609061
Report Date: 11/11/2020
Date Signed: 11/11/2020 05:46:29 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
11/06/2020 and conducted by Evaluator Yelena Avetisyan

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20201106142355

FACILITY NAME:	WEST VALLEY ASSISTED LIVING		FACILITY NUMBER:	197609061
ADMINISTRATOR:	MILLAN, JONATHAN		FACILITY TYPE:	740
ADDRESS:	7055 SHOUP AVENUE		TELEPHONE:	(818) 883-7201
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	90	CENSUS: 47	DATE:	11/11/2020
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Jonathan Millan		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Facility is raising rent for SSI resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Yelena Avetisyan initiated a subsequent complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was initiated telephonically at 3:15 pm with Director of operation Chris Salvador.

It is being alleged that licensee is raising the rent for SSI residents. During the investigation LPA conducted interviews with complainant and administrator. According to complainant they received information that Resident 1 (R1's) was given a rent increase notice that is above the board and care rate for Supplementary Security Income (SSI)/State Supplementary Payment (SSP) recipients. Interview with administrator on 11/6/2020 revealed that licensee did issue rent increase to residents, however those increase were not for SSI/SSP residents. Administrator also stated that they have sent out request letters to SSI/SSP recipients requesting verification of their benefits. Copy of the letter with the names of residents who the notices were issued to were submitted to LPA. While reviewing the names LPA observed that R1’s name was not listed. A discussion was held with administrator who was not aware that R1 was an SSI/SSP recipient.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Yelena Avetisyan	TELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:	DATE: 11/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/11/2020

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-20201106142355

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: 11/11/2020

NARRATIVE

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Per Administrator R1 with the assistance of family has always paid above the SSI/SSP rate. Administrator reviewed R1’s admission agreements and submitted copies to LPA. Admission records did not indicate that R1 is an SSI/SSP recipient. Mr. Millan informed LPA that he will meet with the resident and clarify her financial situation and if it is determined that R1 is an SSI/SSP recipient the rent increase will be based on the 2021 SSI/SSP board and care rate.

Based on the information obtained during the course of the investigation allegation is Unsubstantiated at this time.

A telephonic exit interview was conducted/ Copy was provided via email for signature.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Yelena Avetisyan	TELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:	DATE: 11/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/11/2020

LIC9099 (FAS) - (06/04)

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