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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609103
Report Date: 07/11/2025
Date Signed: 07/11/2025 11:59:30 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
07/02/2025 and conducted by Evaluator Raymond Comer
COMPLAINT CONTROL NUMBER: 31-AS-20250702160429
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: 74DATE:
07/11/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Keith BernanbeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff are not following proper medication training-
INVESTIGATION FINDINGS:
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Today, Friday, 7/11/25, at 8:00 am, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannuouned, initial10- day visit to investigate the above allegation. LPA met with Resident Services Director, Keith Bernanbe, presented official CDSS badge identification, and reason for the visit was disclosed.

At 8:15 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 8:35 am to 9:30 am, LPA conducted a tour of facily medication rooms. From 9:45 am, to 11:30 am, LPA conducted interviews with Administrator, and Staff.

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

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
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-20250702160429
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: 07/11/2025
NARRATIVE
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Allegation: Staff are not following proper medication training- The Reporting Party (RP) states that facility Medication Technicians are instructed by Staff#1 (S1) to reuse cups used to distribute medications to residents. RP states that Med Techs buy medication cups with their own personal funds in order to remain in compliance with facility's medication services policy.

LPA interview with Administrator revealed the following: Administrator denies the claim that staff do not comply with the facility medication services policy, stating that all Med Tech staff are provided in-service training requiring all medication cups to be disposed of after use. Per Admin, staff managers are well aware of the medication services policy, and have not instructed staff to retain used medication cups for any reason. Per Admin, facility keeps ample supplies of medication cups in stock, and that the facility has not experienced critical shortages of any supplies to service residents.

LPA conducted interviews with five (5) staff, which revealed the following: All staff interviewed by LPA deny claim of non-compliance with facility medication services policy, stating that staff have taken medication training and are well aware of the proper handling of resident medications, that medication cups used for resident meds distribution are promptly disposed after use. All staff interviewed by LPA state they have not purchased medication cups using personal funds, and that supplies of medication cups are consistently stocked at the facility.

LPA conducted a tour of the facility, which revealed the following: Medication Rooms, located in the Assisted Living Unit, and Memory Care Unit, were observed and found to contain adequate supplies of packaged medication cups to service residents. Staff informed LPA that medications are transferred directly from medication containers and into resident cups, and that their hands do not touch the distributed medication pill/liquid. Moreover, LPA requested S4 and S5 to demonstrate how medications are dispensed and observed that staff are properly following medications procedures.

Based on LPA observations, and interviews with Administrator, and Staff, LPA was unable to find evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview and copy of report provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2