197609061-3-29-2021-31-AS-CHAS-C2FTDP-20210426143839

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609061
Report Date: 03/29/2021
Date Signed: 03/29/2021 01:18:10 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
01/25/2021 and conducted by Evaluator Yelena Avetisyan

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20210125091301

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: 35	DATE:	03/29/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Chris Salvador		TIME COMPLETED:	11:00 PM

ALLEGATION(S):

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Food Services is inadequate..

INVESTIGATION FINDINGS:

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An unannounced subsequent complaint visit was conducted on this day by Licensing Program Analyst (LPA) Yelena Avetisyan. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was initiated Virtually at 12:40 pm with Director of Opearations and Interim Administrator Chris Salvador

During the initial 10 day complaint visit which was conducted on 1/25/2021 LPA conducted a tour of the facility kitchen, reviewed the licensees menu and interviewed the administrator. Prior to the 1/25/2021 LPA conducted interview with complainant. On 3/24/2021 LPA conducted interview with Resident 1 (R1) who was named in the complaint. Interviews conducted revealed the following. According to complainant on 1/24/2021 the dinner served to R1 was inadequate. When interviewed R1 denied having any complaints about the food that is served to them. According to administrator if a resident does not like the food being served they have alternatives available. If a resident feels the food is cold, undercooked, overcooked they will replace the meal if it is brought to their attention. Based on the information obtained the allegation is Unsubstantiated at this time. A telephonic exit interview was conducted/ Copy was provided via email for signature.

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: 03/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021

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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