197609641-4-14-2023-29-AS-DPEA-CR923Y-20230425170307

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609641
Report Date: 04/14/2023
Date Signed: 04/14/2023 03:11:32 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-20210715105914

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: 92	DATE:	04/14/2023
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Jeanne Skondin		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff were not sufficient in numbers to meet residents 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, (4) residents and (3) staff as well as reviewed and obtained copies of pertinent documents relevant to the investigation. On 03/07/2023, LPA Balisi conducted interviews with (5) residents during a subsequent visit on a separate investigation. Today LPA Balisi conducted physical plant, interviewed residents and staff as well as reviewed and obtained additional pertinent documents relevant to the investigation.

It was reported that Staff were not sufficient in numbers to meet residents needs as it was alleged, at the time of the complaint, there were not enough caregivers scheduled to meet the needs of the residents.

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: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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-20210715105914

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: 04/14/2023

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's records review of caregivers scheduled from 07/01/2021 - 07/31/2021, revealed there were at least three (3) to four (4) caregivers scheduled per shift along with a med tech. During the NOC shift, there were two (2) caregivers and a med tech scheduled. LPA's Interview with fourteen (14) residents, with (13) of those residents residing at the facility during the time of the complaint, revealed that (13) residents did not express any concerns with the ability of staff to meet their needs during the time of the complaint. Furthermore most residents revealed they were satisfied with the quality of service from the staff at this time. LPA's interview with Resident Service Coordinator Tommi Godina revealed , that during the time of the complaint the facility never required the use of outside agencies to cover shifts. Although they did experience some call outs during that time, due to COVID-19, shifts were either covered by Godina, their LVN Sofiya Zaretsky , the Executive Director during that time, or as a last resort , any staff who was able to pick up extra shifts. LPA's interview with twelve (12) staff , with nine (9) of those staff employed by the facility during the time of the complaint, revealed that if there were call outs, other staff who were available to work were asked to cover, if the Resident Service Coordinator or the LVN were not able to do so. Most staff interviewed revealed they don't recall a significant amount of call outs occurring during that time and they were able to meet the needs and services of the residents without any delay. Based on information obtained during this and previous visits, The Department does not have sufficient evidence to prove this allegation occurred. Therefore, the allegation that staff were not sufficient in numbers to meet residents needs has been deemed UNSUBSTANTIATED at this time.

Exit interview conducted and copy of the report was issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2