197609641-9-3-2021-29-AS-DPEA-CH8NDT-20220812102252

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609641
Report Date: 09/03/2021
Date Signed: 09/03/2021 12:11:42 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
07/07/2021 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20210707143859

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: 96	DATE:	09/03/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Hannah Meyers - Executive Director		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff took call pendant away from resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint investigation for the above allegation. Upon arrival LPA met with Executive Director Hannah Meyers and explained the reason for the visit.
During the course of the investigation, LPA conducted a physical plant 07/09/2021 as well as interviewed Administrator, staff and residents. LPA also gathered and reviewed facility documentation pertinent to the allegation.

It was alleged that staff took call pendant away from resident, LPA interview with Resident 1 (R1) revealed that no staff has ever taken away R1's pendant. R1 also stated they did not have any immediate or major concerns of any staff, including Staff 1, or resident taking away any of their belongings. During the interview LPA observed pendant hanging from left arm of resident. LPA interview with (9) residents revealed that all have not witnessed or experienced any staff taking anything away from them. Interviews further revealed that all residents did not express any immediate or major concerns of staff , including S1, or resident taking away any of their belongings.

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: 09/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021

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-20210707143859

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: 09/03/2021

NARRATIVE

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Continued from 9099

LPA interviews with (4) staff revealed that they all have not witnessed or have any knowledge of any staff taking away a pendant from R1 or any other residents. Interviews with staff further revealed that all staff did not express any immediate or major concerns of any staff or S1 taking away a pendant or any other items of any resident. Based on information gathered during this and previous visit, the department does not have sufficient evidence to determine that Staff took call pendant away from resident. Therefore the above allegation is UNSUBSTANTIATED at this time.

Exit interview conducted. Report issued and sent via email.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021

LIC9099 (FAS) - (06/04)

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