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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609103
Report Date: 05/16/2025
Date Signed: 05/16/2025 03:27:05 PM

Substantiated


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
05/06/2025 and conducted by Evaluator Raymond Comer
COMPLAINT CONTROL NUMBER: 31-AS-20250506094816
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: 73DATE:
05/16/2025
UNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Vanessa JewellTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Food Service Personnel are performing duties in an unsanitary manner-
INVESTIGATION FINDINGS:
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Today, Friday, 5/16/25, at 7:50 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 8:10 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 8:45 am to 10:45 am, LPA recieved and reviewed documents relevant to the investigation. From 10:50 am to 1:45 pm, LPA conducted a tour of the facility kitchen, interviews with Administrator and Staff.

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

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
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 3
Control Number 31-AS-20250506094816
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: 05/16/2025
NARRATIVE
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Allegation: Food Service Personnel are performing duties in an unsanitary manner- The reporting party (RP) alleges that kitchen staff do not practice proper food handling standards, do not wash dishes thoroughly, and do not wear hair nets while performing their duties as food service staff.
LPA conducted a tour of the facility kitchen which revealed the following:
  • Kitchen equipment- Commercial refrigerators, and freezers and food warmer, were observed as working properly, daily logs show refrigerators kept at minimum internal temperature of 40 degrees Fahrenheit, freezers kept at minimum internal temperature of 0 degrees Fahrenheit. Food Warmer was observed at minimum internal temperature of 160 degrees Fahrenheit. However, commercial dishwasher temperature gauge was unreadable, and daily dishwashing temperatures are not logged by staff.
  • Work area sanitation- Serving dishes, glasses, eating utensils, etc... were observed as thoroughly cleaned and free of food debris. Kitchen floors, Food storage areas, internal compartments of refrigerators, freezers, and food warmers were observed as clean, free of dirt, grime, spillage, rodents, vermin, or insects.
  • Food service staff hygiene- All food service staff were observed wearing hairnets. However, two (2) of a total three (3) food service staff working in the kitchen were observed as not wearing gloves.
  • Cross Contamination Prevention- All meats and vegetables observed as properly stored, food prep surfaces were observed as clean; food storage containers were securely closed.

Based on LPA observations and interviews, staff failed to provide required food service service sanitation practices. Therefore, the allegation is deemed SUBSTANTIATED at this time.

Exit interview conducted, and report provided. Deficiencies cited on LIC9099D.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250506094816
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/16/2025
Section Cited
CCR
87555(b)(29)
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GENERAL FOOD SERVICE REQUIRMENTS-All equipment...and dishes,shall be kept clean and maintained in good repair and free of breaks, open seams, cracks and chips.
This requirement is not met as evidenced by:
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On, or before 5/30/25, Adminstrator states that repairs will be completed to restore functionality of dishwasher temperature guage and that staff will log dishwasher temperatures on a daily basis.
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Based on LPA observation. Kitchen dishwasher temperature guage is unreadable, and staff were unable to provide a recorded dishwasher temperature log as required in facility's dining services guidelines. This poses an potential risk to the health and safety of clients in care.
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Type B
05/16/2025
Section Cited
CCR
87555(b)(15)
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GENERAL FOOD SERVICE REQUIRMENTS- All persons engaged in food preperation and service shall observe personal hygiene and food service sanitation pratices which protect the food from contamination. This requirement is not met as evidenced by:
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On, or before 5/30/25, Adminstrator states that all food service staff complete in-service trainings regarding personal hygiene and food services sanitation practices.
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Based on LPA observation. Two (2) out of three (3) total food services staff were found working in the facility kitchen without required gloves.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3