197609641-3-7-2023-29-AS-DPEA-CQBS98-20230327134020

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609641
Report Date: 03/07/2023
Date Signed: 03/07/2023 03:35:47 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/15/2021 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20210715121739

FACILITY NAME:	COMMONS AT WOODLAND HILLS, THE		FACILITY NUMBER:	197609641
ADMINISTRATOR:	SOPHIA LUKAS		FACILITY TYPE:	740
ADDRESS:	21711 VENTURA BLVD		TELEPHONE:	(818) 999-2610
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY:	200	CENSUS: 101	DATE:	03/07/2023
		UNANNOUNCED	TIME BEGAN:	09:59 AM
MET WITH:	Jeanne Skondin		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility does not meet residents' dietary needs

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint visit to investigate the allegation listed above. Upon arrival LPA met with Executive Director Jeanne Skondin and explained the reason for the visit.
During the investigation, LPA Martha Guzman Chavez initiated the initial investigation on 07/20/2021 and conducted a physical plant tour, as well as interviewed Executive Director Hannah Meyers, (6) residents and (2) staff as well as reviewed and obtained copies of pertinent documents relevant to the investigation. Today LPA conducted physical plant, interviewed (6) residents and staff as well as reviewed and obtained additional pertinent documents relevant to the investigation.

It was reported that facility does not meet resident's dietary needs as it was alleged that kitchen staff are denying residents certain foods and extra portions. LPA's interviews with twelve (12) resident's revealed that eleven (11) out of the twelve (12) residents stated that if they did not like what was offered on the current menu, they can order something else and the kitchen will prepare it for them as long as they have the supply.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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 29-AS-20210715121739

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMMONS AT WOODLAND HILLS, THE	FACILITY NUMBER: 197609641
	VISIT DATE: 03/07/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from 9099

LPA observed that the kitchen has a sufficient supply of fresh fruits and other perishable and non-perishable food in stock. LPA also observed that an alternative menu is offered to residents upon request, which consisted of Salad, cheeseburger, hot dog, sandwiches, grilled Salmon, grilled chicken, pasta and a variety of other items specifically for breakfast, lunch and dinner.LPA's interview with Executive Chef Jose Larios and (2) dining room staff revealed they have never observed any resident being denied extra portions or any other food related requests. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that kitchen staff are denying residents certain food and extra portions. There, the allegation that facility does not meet resident's dietary needs has been deemed UNSUBSTANTIATED at this time.

Exit interview conducted and copy of report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2