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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609103
Report Date: 05/16/2026
Date Signed: 05/16/2026 01:15:47 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
07/14/2025 and conducted by Evaluator Raymond Comer
COMPLAINT CONTROL NUMBER: 31-AS-20250714151853
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: 67DATE:
05/16/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Summer Rosario-MC DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff do not permit resident to have visitors.
INVESTIGATION FINDINGS:
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On 5/16/26, Licensing Program Analyst, (LPA) Ray Comer conducted an unannounced subsequent facility visit to complete the investigation of the above allegation. An initial visit was conducted on 07/24/2025, at 10:00am by LPA Evelin Rios, at which time LPA Rios requested and reviewed Resident#1's (R1’s) facility file included, but not limited to, Physician report, pre-appraisal, and other records pertaining to the investigation. At 11:15am, LPA Rios spoke to the Residents Service Director (RSD) and five (5) staff present at the facility.
At the time of this visit, LPA Comer requested a copy of the R1’s Power of Attorney, and spoke with Memory Care (MC) Director to discuss R1’s personal rights.

Allegation: Staff do not permit resident to have visitors.

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

DATE: 05/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2026
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-20250714151853
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: 05/16/2026
NARRATIVE
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It was alleged that on 07/13/25. Resident #1 (R1’s) family member arrived to visit R1 and staff informed him that R1’s POA does not allow the family member to visit R1. R1 is competent and is able to make their own decisions.

Staff revealed that R1 was competent enough to let their needs be known. Staff verified that on 07/13/2025 there was a phone argument between R1’s family members. One of the siblings (R1’s POA) did not allow another sibling to visit R1. The staff followed POA's request documented in the facility records and did not allow R1’s family member to see R1. Staff admitted not informing R1 about a family member visiting the facility.

A review of facility records verified that R1 was able to make their own decision to accept or deny visitation.
Based on interviews and records review, there is sufficient information to support the allegation. Therefore, the allegation is substantiated at this time.

Note: LPA Comer spoke with ED and informed them that POA does not extend to residents’ personal rights and Resident should be able to have visitation with a family member at their own will.

Under Title 22 Division 6, Chapter 7, the following citation was issue and recorded on LIC9099D.

Exit interview was conducted, appeal rights were discussed and a copy of report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250714151853
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: 05/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/16/2026
Section Cited
CCR
87468.1(a)(11)
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87468.1 Personal Rights of Residents...(a) Residents...shall have all of the following personal rights: (11)To have their visitors…permitted to visit privately during reasonable hours and without prior notice… This requirement is not met as evidence by:
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A written statement shall be sent to LPA in which Administrator agrees staff shall not infrige on visitation rights of residents, and provide proof of completed in-service staff training regarding resident visitation rights specifically and resident personal rights in general.
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Based on LPA interviews, and records review, Staff did not permit R1’s family member to visit R1, which poses a potential personal rights risk to residents 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: Naira Margaryan
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2026
LIC9099 (FAS) - (06/04)
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