197609496-6-13-2024-31-AS-NMAN-D9MRW6-20241001132236

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609496
Report Date: 06/13/2024
Date Signed: 06/13/2024 01:25:12 PM

Unsubstantiated

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
09/22/2023 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20230922124025

FACILITY NAME:	ENCINO TERRACE SENIOR LIVING		FACILITY NUMBER:	197609496
ADMINISTRATOR:	ARTEAGA, IRMA		FACILITY TYPE:	740
ADDRESS:	16025 VENTURA BLVD		TELEPHONE:	(818) 986-8466
CITY:	ENCINO	STATE: CA	ZIP CODE:	91436
CAPACITY:	85	CENSUS: 42	DATE:	06/13/2024
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Sonia Nault, Executive Director		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Staff is refusing to accept a resident back into the faciltiy

INVESTIGATION FINDINGS:

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Licensing program analyst (LPA) Tihesha Smith made an unannounced complaint visit to this facility to deliver findings. The administrator was present at the facility and LPA Smith met with the administrator and disclosed the purpose of the visit.

Staff is refusing to accept a resident back into the facility It was alleged that the facility refused to accept Resident #1 (R1) back at the facility. To investigate this allegation, during initial visit on 10/02/23, LPA Smith conducted interviews and requested copy of facility documents between 11:35 am-2:20 pm. On 10/17/23, LPA Smith made a subsequent visit and conducted interviews and requested additional documents between 10:12 am -11:48 am. (R1) passed away on 9/26/23. LPA's interview with staff revealed that R1 was never refused to be accepted back into the facility. R1 arrived without notice from the hospital on 9/22/23 and was allowed to return to the facility. Further interviews revealed that the concern was the facility staff was not notified

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230922124025

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: ENCINO TERRACE SENIOR LIVING	FACILITY NUMBER: 197609496
	VISIT DATE: 06/13/2024

NARRATIVE

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(cont from 9099)

by the hospital of R1’s discharge and return back to the facility and the administrator was not afforded time to conduct a reassessment for R1 prior to R1s discharge from the hospital.

Based on interviews there is insufficient information to support the allegation, therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety risks were observed.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

LIC9099 (FAS) - (06/04)

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