197609103-5-6-2025-31-AS-EMIR-DK2NB3-20250729101825

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609103
Report Date: 05/06/2025
Date Signed: 05/06/2025 02:58:32 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
04/29/2025 and conducted by Evaluator Raymond Comer

COMPLAINT CONTROL NUMBER: 31-AS-20250429132801

FACILITY NAME:	HOLLYWOOD HILLS SENIOR LIVING		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: 69	DATE:	05/06/2025
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Vanessa Jewell		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not prevent outbreak of virus-
Facility food warmer is in disrepair-

INVESTIGATION FINDINGS:

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Today, Tuesday, 5/06/25, at 10:15 am, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannuouned, initial10- day visit to investigate the above allegation(s). LPA met with Administrator, Vanessa Jewell, presented official CDSS badge identification, and reason for the visit was disclosed.

At 10:25 am, LPA conducted a physical plant tour; "Frequent Hand Washing" postings promentently displays throughout the facility. Common area dining room, coffee lounge, and bristro, (located in the front lobby) are closed until GI Outbreak has been determined as resolved.

To investigate this allegation, LPA received facility resident roster, and staff roster. From 11:00 am to 2:15 pm, LPA reviewed records, conducted observations, and interviewed staff.

[LIC9099C] Continued---

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

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-20250429132801

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: 05/06/2025

NARRATIVE

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Allegation: Staff did not prevent outbreak of virus- The Reporting Party (RP) alleges that multiple residents are sick from viral outbreak which occurred at the facility approximately "a week and a half ago", or around 4/22/25, and that staff have neglected to prevent viral spread.
LPA review of staff records revealed the following: On Tuesday, 4/22/25, Staff#1 (S1) reported to Los Angeles County Department of Public Health (LACDPH) and Community Care Licensing. (CCL) that five (5) Memory Care Residents were experiencing GI symptoms of loose bowel, diarrhea, and vomiting. Staff correspondence included listing of residents/staff affected by the GI Outbreak.
On Wednesday, 4/23/25, LACDPH Community Outbreak Team Representative confirmed notification of GI Outbreak reported by staff, and that a district public health nurse was assigned for outbreak management.
On Wednesday, 4/30/25, LPA spoke with S1,via telephone, who stated twenty-eight (28) residents and four (4) staff are affected by the GI Outbreak. Per LACDPH Community Health representative, (N1) facility staff have provided updates regarding any change in circumstances.
LPA spoke with S1, during today's on-site observation, who stated the following: A total of thirty-two (32) residents [comprised of fourteen (14) Assisted Living (AL) residents, eighteen (18) Memory Care (MC) residents] and eight (8) staff are affected by the GI Outbreak.
Facility observations conducted by LPA revealed the following: "Notice of Gastrointestinal Exposure", dated 4/22/25 is posted prominently on main doors of facility's entrance. Masks are available upon request. Housekeeping staff were observed cleaning exposed surfaces. (i.e., counter tops, handrails tables, floors, etc...) Staff were observed wearing the proper Personal Protective Equipment. (PPE)

Therefore, based on LPA observations, records review, and interviews with staff, the allegation is Unsubstantiated at this time. Exit interview and copy of report provided.

[LIC9099C] Continued---

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20250429132801

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: 05/06/2025

NARRATIVE

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Allegation: Facility food warmer is in disrepair- RP states facility food warmer is in disrepair, yet is still in use to serve resident meals.
LPA observation of facility kitchen revealed the following: Facility food warmer was tested and found to be working properly; device reached temperature of 164 degrees Fahrenheit at the time of testing.
LPA interviews with staff revealed the following: Staff#2 (S2) states that resident meals are initially temperature checked when placed in the food warmer, and again on a second occasion when meals are transported and delivered to residents. Both Staff#2 and Staff#3 state that the food warmer has been working consistently at the appropriate temperature (140 f. to 165 f) in order to prevent bacterial growth.

Therefore, based on LPA observations, records review, and interviews with staff, 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: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC9099 (FAS) - (06/04)

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