197609641-2-2-2024-29-AS-DPEA-D2VMHX-20240228083813

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609641
Report Date: 01/31/2024
Date Signed: 02/02/2024 02:11:15 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
11/02/2023 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20231102154154

FACILITY NAME:	COMMONS AT WOODLAND HILLS, THE		FACILITY NUMBER:	197609641
ADMINISTRATOR:	JEANNE SKONDIN		FACILITY TYPE:	740
ADDRESS:	21711 VENTURA BLVD		TELEPHONE:	(818) 999-2610
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY:	200	CENSUS: 93	DATE:	01/31/2024
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Kevan Sidney		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not obtain appropriate assistance for resident engaging in self-risk behaviors

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced subsequent complaint visit to conclude investigation and issue finding regarding allegation listed above. Upon arrival LPA met with the Executive Director Kevin Sidney and explained the reason for the visit.

Following is a summary of the allegation and investigation finding:

On 11/02/2023, It was reported that facility staff reported being concerned about resident #1’s (R1) well-being yet did not take the appropriate steps to obtain assistance. Information was received that R1 seemed to be under the influence of alcohol and marijuana; was violent with staff and not allowing staff to enter the room to provide service.
On 11/08/2023, at approximately 2:15pm, LPA Chochian conducted an initial complaint visit. During the initial visit a physical plant tour was conducted with staff and LPA was able to communicate with four (4) random residents and R1 from approximately 2:15 to 3pm.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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 29-AS-20231102154154

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: 01/31/2024

NARRATIVE

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Random residents interviewed did not report any inappropriate behavior from staff or any other facility resident. R1 expressed not wanting to be bothered by anyone; does not want staff coming into the room. R1 expressed having to be able to care for self needs at this time and will ask for assistance from staff if needed. Between 3pm-3:30pm LPA met with and interviewed staff, reviewed, and obtained copies of R1’s records. Staff reported that when R1 was exhibiting violet behavior R1’s case worker was notified of the behavior episodes and that R1 was provided with a warning for violating house rules and non-payment of rent. Staff reported that they did not feel R1’s behavior warranted Law Enforcement assistance. Staff stated that they reached out to R1’s case work in efforts to gain assistance with R1; regarding unpaid rent, complying with care services and/or to discuss an alternative placement for R1.

R1’s case worker was contacted on 11/9/2023 and reported that she was unaware of R1’s behavior towards the facility staff and that R1 was behind on rent. Case worker reported that she recently found out from the facility, and she encouraged staff to contact law enforcement if they feel R1 is a danger to self or others in the community. According to staff there was no apparent life-threatening incident for staff to contact law enforcement for assistance at the time. Staff also reported that R1 at times would not allow staff in but eventually when staff would check back R1 would allow certain staff in the room.

During today’s visit LPA conducted a brief physical plant tour with staff at approximately 3:30pm and additional interviews were conducted with five (5) random residents. Five out five residents interviewed today expressed that they like the facility and did not report any inappropriate behavior from staff or facility residents.

Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Staff did not obtain appropriate assistance for resident engaging in self-risk behaviors” is deemed unsubstantiated at this time.

Exit interview conducted. A copy of the report provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC9099 (FAS) - (06/04)

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