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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609103
Report Date: 10/30/2025
Date Signed: 10/31/2025 08:06:56 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/24/2025 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20251024095352
FACILITY NAME:HOLLYWOOD HILLS SENIOR LIVINGFACILITY NUMBER:
197609103
ADMINISTRATOR:VANESSA JEWELLFACILITY TYPE:
740
ADDRESS:1745 N GRAMERCY PLACETELEPHONE:
(323) 994-6700
CITY:LOS ANGELESSTATE: CAZIP CODE:
90028
CAPACITY:120CENSUS: 64DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Vanessa Jewell, AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff do not ensure facility is kept clean, safe, sanitary and in good repair at all times
Staff does not ensure facility furniture is in good repair
INVESTIGATION FINDINGS:
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At approximately 09:25am, Licensing Program Analyst (LPA) Angela Panushkina and Licensing Program Manager (LPM) Nichelle Gillyard conducted an unannounced complaint visit in response to the above-mentioned allegations. LPA and LPM met with the Administrator and explained the reason for the visit.

At 09:30am, LPA and LPM requested resident and staff roster. At 09:35am, LPA and LPM requested copies of pertinent information which include, but not limited to Maintenance Log and annual Fire Inspection. Between 09:50am – 12:00pm, LPA and LPM conducted an interview with the Administrator and one (1) resident.

Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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 6
Control Number 31-AS-20251024095352
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: HOLLYWOOD HILLS SENIOR LIVING
FACILITY NUMBER: 197609103
VISIT DATE: 10/30/2025
NARRATIVE
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Allegation: Staff do not ensure facility is kept clean, safe, sanitary and in good repair at all times

It was alleged that the facility floors are dirty and the facility is kept in an unsanitary condition. To investigate this allegation, LPA and LPM conducted a physical plant tour at 10:09am and visited random resident rooms on the 2nd, 3rd and 4th floors. At 10:16am, LPA and LPM observed a smear in the bathroom wall. At 10:23am, upon entry to the room #2011 LPA observed scrape on the wall, the room smelled like urine, and one (1) outlet cover was broken and needed to be replaced. At 10:33am, LPA and LPM observed room #2008 had a crack on the stucco that needed to be fixed. At 10:40am, during the physical plant tour LPA and LPM observed room #3016 (1-2) carpets were dirty and had stains. At 10:50, LPA and LPM observed a strong smell of urine in room #3007. At 10:45am, room #3014 dresser's two (2) handles were observed broken and required to be replaced. At 10:51am, LPA and LPM observed the top portion of the dresser (in room #3007) was missing. Lastly, all trash cans, in nine (9) bathrooms, were missing fitted lids. Administrator was informed that all trash cans must have a fitted lid to protect them from cross contamination. Therefore, based on LPA and LPM observation, this allegation is Substantiated.

Allegation: Staff does not ensure facility furniture is in good repair

It was alleged that the dinning room furniture is wobbly and the chairs are in bad condition and need to be replaced. To investigate this allegation, LPA and LPM conducted a physical plant tour at the Memory Care Unit (on a 2nd floor) dining room area. LPA and LPM inspected fifteen (15) out of fifteen (15) chairs and didn’t observe any issues. However, two (2) out of ten (10) tables were confirmed to be unsteady and wobbly which is a potential hazard for falling apart while being used. Both tables were immediately removed during today’s visit. Based on LPA and LPM observation this allegation is Substantiated.

Deficiency issued on LIC9099-D

Exit interview conducted, appeal rights explained and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 31-AS-20251024095352
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 10/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/07/2025
Section Cited
CCR
87303(a)
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The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
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During today's visit, two (2) wobbly dining table were removed from the Memory Care Unit. Licensee/Administrator agreed to have faclitity carpet cleaned, replace all broken/damaged dressers and paint chipped/molded walls/doors. Pictures will be submitted to LPA by POC date.
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Based on LPAs observation, the licensee did not comply with the section cited above by having a dirty carpet in multiple resident rooms and in hallways, including chipped walls/doors, and missing paint on the walls/doors (throughout the facility).Which poses/posed a potential health and safety risk to persons in care.
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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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/24/2025 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20251024095352

FACILITY NAME:HOLLYWOOD HILLS SENIOR LIVINGFACILITY NUMBER:
197609103
ADMINISTRATOR:VANESSA JEWELLFACILITY TYPE:
740
ADDRESS:1745 N GRAMERCY PLACETELEPHONE:
(323) 994-6700
CITY:LOS ANGELESSTATE: CAZIP CODE:
90028
CAPACITY:120CENSUS: DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Vanessa Jewell, AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff does not ensure facility floors are maintained in good repair
Staff does not ensure facility is kept free of hazardous obstructions
Staff do not ensure restricted area of facility is safely secured
INVESTIGATION FINDINGS:
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At approximately 09:25am, Licensing Program Analyst (LPA) Angela Panushkina and Licensing Program Manager (LPM) Nichelle Gillyard conducted an unannounced complaint visit in response to the above-mentioned allegations. LPA and LPM met with the Administrator and explained the reason for the visit.

At 09:30am, LPA and LPM requested resident and staff roster. At 09:35am, LPA and LPM requested copies of pertinent information which include, but not limited to Maintenance Log and annual Fire Inspection. Between 09:50am – 12:00pm, LPA and LPM conducted an interview with the Administrator and one (1) resident.

Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 31-AS-20251024095352
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: HOLLYWOOD HILLS SENIOR LIVING
FACILITY NUMBER: 197609103
VISIT DATE: 10/30/2025
NARRATIVE
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Allegation: Staff does not ensure facility floors are maintained in good repair

It was alleged that the facility carpets are loose which is a tripping hazard. To investigate this allegation, LPA and LPM conducted an interview with the Administrator and were informed that the facility has carpets on the 3rd, 4th and 5th floors. At some places, LPA and LPM observed the carpets were slightly loose. However, it’s not a tripping hazard. The carpets are not frayed, not torn and you are able to walk over without catching your shoe, walker or the wheelchair. The Administrator was already aware of this situation and informed LPA and LPM that an order had been placed to fix the carpets. Proof of document was obtained during today ‘s visit. Therefore, based on interview, document review, LPA and LPM observation this allegation is deemed Unsubstantiated, at this time.

Allegation: Staff does not ensure facility is kept free of hazardous obstructions

It was alleged that the parking garage has a water leak and there are hazards due to being over filled with equipment. LPA and LPA along with the Administrator toured the garage area and observed a large storage area that contained various large items. The maintenance room was not accessible to residents in care. LPA observed random furniture out of the way, placed by residents' family for disposal when they left. Furniture is not stored in an obstructive hazard. Therefore, based on LPA and LPM observation and information gathered during today's visit this allegation is Unsubstantiated, at this time.

Allegation: Staff do not ensure restricted area of facility is safely secured

It was alleged that the staff do not ensure the door to the roof top of the building is kept locked to prevent residents from having access. To investigate this allegation, LPA and LPM along with the Administrator conducted a physical plant tour of the facility. At 11:35am, LPA and LPM observed that the roof access had no lock. Room #7709, which is independent and not part of the licensed facility, is located across from the roof top door and is the only room that has access to outside. At 1:02pm, LPA contacted the Fire Inspector and confirmed that the fire door and access to the roof should not be locked. Therefore, based on LPA and LPM observation and information gathered during today’s visit, this allegation is deemed Unsubstantiated at this time.

No deficiency cited

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6