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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609103
Report Date: 04/03/2025
Date Signed: 04/03/2025 02:48:55 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
03/24/2025 and conducted by Evaluator Raymond Comer
COMPLAINT CONTROL NUMBER: 31-AS-20250324110641
FACILITY NAME:HOLLYWOOD HILLS SENIOR LIVINGFACILITY NUMBER:
197609103
ADMINISTRATOR:VANESSA JEWELLFACILITY TYPE:
740
ADDRESS:1745 N GRAMERCY PLACETELEPHONE:
(323) 467-3121
CITY:LOS ANGELESSTATE: CAZIP CODE:
90028
CAPACITY:120CENSUS: 69DATE:
04/03/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Vanessa JewellTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff are not able to provide care services to resident in care-
INVESTIGATION FINDINGS:
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Today, Thursday, 4/03/25, at 9:50 am, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannuouned initial10- day visit to investigate the above allegation. LPA met with Administrator, Vanessa Jewell, presented official CDSS badge identification, and reason for the visit was disclosed.

At 10:10 am, LPA conducted a physical plant tour; no health and safety issues were observed.

To investigate this allegation, LPA received facility resident roster, and staff roster. From 10:20 am to 11:45 am, LPA conducted interviews with staff, reporting party (RP), and responsible family member (F1). LPA reviewed resident records and interviewed residents from 12:15 pm to 2:20 pm. LPA received copies of the Admissions Agreement, Physician Communications, Hospital "After-Visit" Summaries, Staff "Narritive Charting", Physician’s Report (LIC 602), and Needs/Service Plans.

[LIC9099C] Continued---
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20250324110641
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: HOLLYWOOD HILLS SENIOR LIVING
FACILITY NUMBER: 197609103
VISIT DATE: 04/03/2025
NARRATIVE
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Allegation: Staff are not able to provide care services to residents- The RP alleges that Resident#1 (R1) is not provided care by staff. LPA contacted the RP, via phone, who stated the following: Staff called 911 on several occasions to send R1 to the hospital. RP states that R1 had no medical issues which required emergency services and said to LPA that facility staff are simply "wasting public resources".
LPA review of R1's file revealed the following: Physician's report identifies R1 as diagnosed with dementia and altered mental status. R1 was assessed and admitted to the facility as a Memory Care (MC) resident in October of 2024; R1's daughter is acting Power of Attorney (POA). Unusual Incident Reports, with occurrences dated 3/23/25, and 3/35/25, describe R1 as sustaining fall injuries and exhibiting aggressive behavior which necessitated staff to call for 911 emergency services. Incident reports indicate that R1's Primary Care Physician (PCP), Neurologist, and POA were informed by facility staff.
LPA interview with Staff and Administrator revealed the following: Both Administrator, S1 and S2 refute this allegation, stating that R1 is provided adequate staff care and supervision, and that 911 emergency service calls made by staff on R1's behalf were necessary to provide R1 proper health assessment and timely medical treatment.
LPA interview with R1's Responsible Family Member (F1) revealed the following: F1 states that facility staff provide them timely communications regarding all incidents involving R1. F1 states she is confident that facility staff are providing R1 proper care and supervision.
LPA interviews with seven (7) residents revealed the following: Seven (7) out of seven (7) residents state that staff provide satisfactory care and supervision.

Therefore, based on LPA interviews with staff, residents, responsible family member, and documents review, the allegation is Unsubstantiated at this time. Exit interview and copy of report provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2