197609103-8-16-2024-31-AS-EMIR-D9GLD7-20240926083924

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609103
Report Date: 08/16/2024
Date Signed: 08/16/2024 03:35:06 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.RO, 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
07/24/2024 and conducted by Evaluator Raymond Comer

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240724164758

FACILITY NAME:	PACIFICA SENIOR LIVING HOLLYWOOD HILLS		FACILITY NUMBER:	197609103
ADMINISTRATOR:	VANESSA JEWELL		FACILITY TYPE:	740
ADDRESS:	1745 N GRAMERCY PLACE		TELEPHONE:	(323) 467-3121
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90028
CAPACITY:	120	CENSUS: 73	DATE:	08/16/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Administrator-Vasessa Jewell		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff is providing false information to residents.

INVESTIGATION FINDINGS:

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Today, Friday, 8/16/2024, Licensing Program Analyst, (LPA) Raymond Comer conducted a subsequent complaint visit regarding the allegation listed above. LPA conducted the initial10-day complaint visit on 8/02/24.

At 9:25 AM, LPA met with facility Administrator, Vanessa Jewell, and the purpose of the visit was disclosed. A physical plant tour of the facility was conducted. No health and safety issues were observed.

Allegation: Staff is providing false information to residents-

During the subsequest complaint visit, LPA conducted interviews with residents and staff.

[LIC 9099C Continued]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond Comer	TELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

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-20240724164758

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: PACIFICA SENIOR LIVING HOLLYWOOD HILLS	FACILITY NUMBER: 197609103
	VISIT DATE: 08/16/2024

NARRATIVE

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Six (6) out of the seven (7) residents interviewed stated they have neither heard, nor witnessed the Administrator providing false information.

Five (5) out of the seven (7) staff interviewed stated they have neither heard, nor witnessed the Administrator providing false information. Thus, Staff and Resident interviews do not corroborate this allegation.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the alleged violation did, or did not occur. Based on LPA's observations, interviews, and documents review, the allegation is UNSUBSTANTIATED.

An Exit interview was conducted, and report was provided to the Administrator.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond Comer	TELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024

LIC9099 (FAS) - (06/04)

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