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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609103
Report Date: 12/13/2025
Date Signed: 12/13/2025 11:05:15 AM

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
07/30/2025 and conducted by Evaluator Angelica Segovia
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250730105811
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: 66DATE:
12/13/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Vanessa Jewell- Regional Director of OperationsTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Medication mismanagement contributed to residents death.
Staff are not dispensing medication as prescribed.
INVESTIGATION FINDINGS:
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On 12/13/2025 at approximately 10:30 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced subsequent complaint visit to the facility. LPA was greeted by the staff members and stated the reason for their visit was to deliver the findings of the complaint. The Regional Director of Operations, Vanessa Jewell, arrived shortly after to assist with today’s visit.

To investigate the allegation(s), on 07/31/2025 at approximately 10:00 AM, LPA conducted a physical plant tour. By 11:00 AM, LPA requested relevant documentation. From 11:30 AM to 2:00 PM, LPA conducted record review. On 10/16/2025 LPA conducted a subsequent visit to the facility to conduct interviews and additional record review. LPA attempted to interview five (5) staff members (S1-S5).

(Continue to LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2025
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-20250730105811
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: 12/13/2025
NARRATIVE
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Regarding the allegation: Medication mismanagement contributed to residents death. It is being alleged that staff members S2 and S5 are purposely providing false information to hospice pertaining to residents’ medication which resulted in the death of two (2) residents (R1-R2). To investigate the allegation, LPA conducted record review of both R1’s and R2’s files. Record review revealed that R1 was admitted to Gentle Touch Hospice on 9/26/2023 due to a decline in their condition as a result of their medical diagnosis. On 9/02/2025, LPA requested R1’s medical records from hospice. Record review revealed that R1 was placed on various medications due to their diagnosis. The medication in question (per the Reporting Party) was allegedly discontinued by S5 which caused R1’s death on 4/17/2024. However, LPA’s record review of R1’s Interdisciplinary Group Review (IDG) showcased that R1’s attending physician had placed the order to discontinue said medication on 4/14/2024. The order to discontinue the medication was documented to be due to R1 being, “…susceptible to bruising while on anticoagulant” (page 2). Additional record review confirmed R1 was observed during hospice visits to have had a change of condition resulting in their Plan of Care being updated to meet R1’s needs until their time of death. LPA’s review of R1’s Certificate of Death documented their death to have been contributed by both cardiac arrest and cognitive decline.

LPA’s record review of R2’s file revealed that R2 was admitted to Easy Care Hospice on 9/13/2024 due to a decline in their condition related to their medical diagnosis. On 9/02/2025, LPA requested R2’s medical file from Hospice. Record review revealed that R2 was placed on various medications due to their diagnosis. The medication in question (per the Reporting Party) was allegedly requested to be discontinued by S5 which caused R2’s death on 7/17/2025. However, LPA’s record review showcased that R2 had been sent to the hospital on 9/06/2024, where an order to discontinue the medication in question was placed by the attending physician on 9/11/2024. Additional record review of R2’s Physician’s Orders (6/02/2025 to 7/15/2025) showed no record of said medication listed. LPA’s record review of R2’s Certificate of Death documented their death to have been contributed to both cardiac arrest and cognitive decline.

It was also alleged staff are receiving compensation for hospice enrollment. LPA’s interview with S2 regarding whether they are receiving any compensation through monetary gains for residents being admitted into Hospice were denied. LPA’s interview with S1 revealed that they would “fire” any staff that would partake in any financial gain through residents being admitted into hospice. LPA attempted to interview S5 but S5 no longer works at the facility and could not be contacted.

Based on record review and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. (Continue to LIC 9099-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250730105811
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: 12/13/2025
NARRATIVE
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Regarding the allegation: Staff are not dispensing medication as prescribed. It is being alleged that staff are not administrating medication as prescribed. To investigate the allegation LPA conducted interviews with four (4) staff members. All four (4) staff members confirmed that resident’s medications are administered as prescribed. During LPA’s physical plant tour, LPA observed the medication rooms located in both the Assisted Living Unit and the Memory Care Unit. LPA observed, at random, a total of ten (10) residents’ medications. LPA observed all ten (10) residents' medications to be labeled correctly, assigned to the correct person and administered on the correct date.

Based on interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No immediate health and safety issues observed during the day of the visit. Exit interview conducted and a copy of this report was provided to The Regional Director of Operations.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3