197609641-1-20-2023-29-AS-JAPL-CNLSKR-20230131125709

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609641
Report Date: 01/20/2023
Date Signed: 01/20/2023 04:30:05 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
07/30/2021 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20210730112201

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: 98	DATE:	01/20/2023
		UNANNOUNCED	TIME BEGAN:	08:57 AM
MET WITH:	Jeanne Skondin		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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1. Facility is requiring quarantine for all residents.
2. Facility canceled scheduled activities.
3. Facility is not allowing communal dining.
4. Food service is inadequate.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Christine Yee conducted a subsequent unannounced complaint visit to conduct additional interviews and to render a finding for the above allegations. LPA Yee met with Jeanne Skondin, Staff and the reason for today's visit was explained.

On 8/5/2021, an unannounced initial complaint visit was conducted by LPA Brian Balisi. During the visit, LPA Balisi conducted a tour of the physical plant with Hannah Meyers, Executive Director and interviewed staff. LPA also reviewed and obtained copies of pertinent documents relevant to the investigation. Based on the information obtained during the visit, LPA Balisi determined that further investigation was needed.

continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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-20210730112201

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: COMMONS AT WOODLAND HILLS, THE	FACILITY NUMBER: 197609641
	VISIT DATE: 01/20/2023

NARRATIVE

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On 9/3/21, LPA Balisi continued his investigation and conducted interviews with facility residents.

On today's visit LPA Yee conducted additional interviews with staff, residents, toured the kitchen, inspected perishable and non-perishable food supplies and observed today's lunch and residents in the dining room.

Based on the investigation into allegations #1: Facility is requiring quarantine for all residents, allegation #2: Facility canceled scheduled activities and allegation #3: Facility is not allowing communal dining and the following information was obtained:

The facility had conducted testing and a staff was tested positive for Covid-19 on 7/27/21. An email was sent out to notify the responsible parties and families on 7/28/21. A second staff who does not have direct contact with the residents received positive Covid-19 results on 7/29/21. A second notification email was sent to the responsible parties and families advising them that the facility would be conducting mass testing and limiting their communal dining and activities until everyone cleared the next round of testing. Per interview with the VP of Operations, Sophia Lukas, residents were exhibiting symptoms and they did not know if it was Covid-19 related. As part of his investigation, LPA Balisi made contact with the public health nurse and verified the recommendation that was made to limit communal dining and activities as a precaution to mitigate the spread of Covid-19 until each resident and staff was cleared through testing. LPA Yee also spoke with the public health nurse and confirmed the recommendation that would have been made to the facility. Based on the information obtained, allegation #1 through allegation #3 would be UNSUBSTANTIATED.

In regards to allegation #4 - Food service is inadequate. A tour of the kitchen was conducted and perishable and non-perishable foods were reviewed. Per tour of the kitchen, the following was observed: The walk-in refrigerator was observed with large metal trays of broccoli, zucchini, yellow neck squash, tomatoes, cabbage, bell peppers,

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210730112201

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: COMMONS AT WOODLAND HILLS, THE	FACILITY NUMBER: 197609641
	VISIT DATE: 01/20/2023

NARRATIVE

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carrots, cauliflower, mushrooms, lettuce, lemons, celery, strawberries, apples, avocados and 3 large bags of spinach. Also observed were 6 gallons of milk, 8 half gallons of almond milk and 12 gallons of orange juice. At 11:59am, LPA Yee observed the food that was prepared for lunch and residents having lunch in the dining room. Lunch consisted of a turkey burger with lettuce and tomatoes, seasoned fries and a garden salad. The residents have other options if they don't like what's on the menu. Per the kitchen staff, vegetables are not cooked in advance for lunch and are cooked upon request. Staff also indicate that they have plenty of milk and don't tell residents that they don't have something . A resident was observed having an egg salad sandwich. Per staff interviewed, vegetables are offered for lunch and dinner. The only vegetables used at breakfast are mushrooms, spinach and tomatoes in omelettes. Per residents who were interviewed, the facility serves them vegetables with all their meals whether they want it or not. Some residents indicated that they don't like vegetables and won't eat them. A couple of residents indicated that they are finicky eaters and like their food cooked a certain way. The residents interviewed indicated that sometimes they like the food on the menu and sometimes they don't. They have their own food preferences.

Based on the information obtained, the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Jeanne Skondin and a copy of the report was provided.

No Citations were issued on today's visit.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC9099 (FAS) - (06/04)

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