197609641-5-31-2024-29-AS-DPEA-D5T3PX-20240531182616

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609641
Report Date: 05/31/2024
Date Signed: 05/31/2024 03:03:31 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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 Valeria Conway

COMPLAINT CONTROL NUMBER: 29-AS-20231018134438

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: 102	DATE:	05/31/2024
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Kevin Sidney		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff are not following proper reporting requirements

INVESTIGATION FINDINGS:

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censing Program Analysts (LPA)'s Brian Balisi and Valeria Conway conducted an unannounced subsequent complaint visit to deliver final findings for the allegation listed above. Upon arrival LPAs met with Kevin Sidney and explained the reason for the visit.

On 10/24/2023, from 10am - 2pm, LPA conducted an unannounced complaint visit. During the visit LPA toured physical plant, interviewed staff and reviewed and obtained copies of pertinent documentation relevant to the investigation. On 02/23/2024, LPA interviewed four (4) families / responsible parties of residents in care.

It was reported that Staff are not following proper reporting requirements, as it was alleged that Executive Director Jeanne Skondin has informed staff not to report any positive cases to responsible parties or local agencies.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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-20231018134438

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMMONS AT WOODLAND HILLS, THE	FACILITY NUMBER: 197609641
	VISIT DATE: 05/31/2024

NARRATIVE

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Continued from 9099

Interviews conducted and records review reflected that on 10/16/2023 one (1) resident tested positive for COVID-19. On 10/17/2023, seven (7) residents tested positive for COVID-19. No communication was made with CCL. Staff #1 (S1) stated they notified Public Health on 10/18/2023. LPA's interview with Staff #1 (S1) revealed incident reports (LIC624) were created for each positive case, but they were awaiting approval from the Executive Director to send to the appropriate agencies. LPA's interview with six (6) staff revealed all (6) do not recall Skondin informing staff not to report the COVID positive cases. LPA's interview with four (4) families / responsible parties of residents in care revealed that each were informed of the COVID positive cases in a timely manner. Based on the information obtained during the course of the investigation, the Department concluded that there was sufficient evidence to substantiate the allegation. Therefore, the allegation "Staff are not following proper reporting requirements" is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 9099-D)

Exit interview conducted, appeal rights discussed, and a copy of this report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

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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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMMONS AT WOODLAND HILLS, THE	FACILITY NUMBER: 197609641
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/31/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/01/2024 Section Cited CCR 87211(a)(2)	1 2 3 4 5 6 7	Occurrences, such as epidemic outbreaks...24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirment was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agreed to submit a plan to ensure occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents will be reported to CCL within 24 hours and submit plan to LPA via email by 6/01/24
	8 9 10 11 12 13 14	Based on record review, the licensee did not comply with the section cited above when the facility did not report an epidemic outbreak within 24 hours, which poses an immediatel health, safety and personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

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