197609641-9-11-2024-29-AS-DPEA-D9GTPP-20240926145436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609641
Report Date: 09/10/2024
Date Signed: 09/11/2024 08:31:04 AM

Unsubstantiated

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
06/27/2024 and conducted by Evaluator Valeria Conway

COMPLAINT CONTROL NUMBER: 29-AS-20240627111756

FACILITY NAME:	COMMONS AT WOODLAND HILLS, THE		FACILITY NUMBER:	197609641
ADMINISTRATOR:	KEVAN SIDNEY		FACILITY TYPE:	740
ADDRESS:	21711 VENTURA BLVD		TELEPHONE:	(818) 999-2610
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY:	200	CENSUS: 102	DATE:	09/10/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Kevan Sidney		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Facility staff are not properly addressing an outbreak of scabies.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Valeria Conway conducted a subsequent complaint visit to the facility regarding the above noted allegation. LPA met with Executive Director (ED) Kevan Sidney and explained the reason for the visit.

It was alleged that the facility had a scabies outbreak, however, the facility failed to properly address he outbreak.

During the course of the investigation, on 07/02/2024, LPA conducted a tour of the physical plant with ED and requested relevant documents. Additionally, LPA interviewed staff, family members and hospice staff. Records reviewed reflected that two (2) residents, Resident #1 (R1) and Resident #2 (R2) experienced rashes and itchiness on their bodies on or around 06/18/2024. On 06/19/2024, True Care Hospice prescribed R1 and R2 Invermectin for an indication of scabies.
Continues on LIC 9099-C

Unsubstantiated

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: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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-20240627111756

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: 09/10/2024

NARRATIVE

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Continued from LIC 9099

Additionally, records reflected that on 06/21/2024, hospice ordered a scabies skin test which was conducted on 06/24/2025. On 06/25/2024, test for both residents reflected negative results for scabies. On 08/21/2024, R1 was prescribed Calamine 8% (lotion) for itching/irritation.

Interviews with staff reflected that, Staff #1 (S1) and Staff #2 (S2), were taking care of R1 and R2. These staff also had a rash, itchy bumps and blisters on their body. Staff purchased over the counter allergy medicine before bringing this issue to management. After seeing that itchiness was persisting, S1 and S2 spoke to management and were sent by the facility to the doctor for an evaluation. However, per interviews a skin test was not conducted for both staff to confirm if they in fact had scabies but both staff were prescribed Invermectin and Atarax 25 mg. During the course of the investigation, LPA requested medical records for both staff, however, did not receive any documentation to support the allegation.

Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Facility staff are not properly addressing an outbreak of scabies” is deemed Unsubstantiated at this time.

Exit interview conducted/Appeal rights discussed/A copy of report provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC9099 (FAS) - (06/04)

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