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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609641
Report Date: 10/24/2023
Date Signed: 10/24/2023 01:32:44 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
10/18/2023 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20231018134438
FACILITY NAME:COMMONS AT WOODLAND HILLS, THEFACILITY NUMBER:
197609641
ADMINISTRATOR:JEANNE SKONDINFACILITY TYPE:
740
ADDRESS:21711 VENTURA BLVDTELEPHONE:
(818) 999-2610
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY:200CENSUS: 96DATE:
10/24/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jeanne Skondin - Executive DirectorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff are not following proper infection control requirements

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced complaint visit for the allegations listed above. Upon arrival LPA met with Executive Director Jeanne Skondin and explained the reason for the visit.

At approximately 10:15am, LPA conducted physical plant, interviewed staff and reviewed and obtained pertinent documentation relevant to the investigation.

It was reported that staff are not following proper infection control requirements as it was alleged that PPE was not being provided to caregivers who assisted residents that tested positive for COVID-19. Interviews conducted with eight (8) staff along with the Executive Director Jeanne Skondin, revealed that eight out of the nine staff interviewed revealed that a sufficient supply of PPE was provided to them as soon as they were aware of the first positive case on 10/16/2023. Interviews with staff further revealed, PPE supplies and trash cans with lids were also located by the doors of each resident who had tested positive.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
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 3
Control Number 29-AS-20231018134438
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: 10/24/2023
NARRATIVE
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Continued from 9099

During physical plant , LPA observed at least a 30 day supply of surgical masks, gowns, gloves, and hand sanitizer properly stored and easily accessible in two (2) storage areas in the facility. Based on information obtained throughout the course of the investigation, the department does not have sufficient evidence to determine Staff are not following proper infection control requirements. Therefore, the above allegation is deemed unsubstantiated at this time.

Exit interview conducted and a copy of report issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3