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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609889
Report Date: 03/22/2024
Date Signed: 03/22/2024 03:46:54 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/15/2024 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20240315142734
FACILITY NAME:PEARL OF WEST HILLS, INCFACILITY NUMBER:
197609889
ADMINISTRATOR:IRINA, KARBACHINSKIYFACILITY TYPE:
740
ADDRESS:23427 VICTORY BLVDTELEPHONE:
(818) 854-6306
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 3DATE:
03/22/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Olga KnyazevaTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff member is physically abusing a resident
Staff member is verbally abusing a resident
INVESTIGATION FINDINGS:
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At 3:00 p.m. on 03/22/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with staff and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 03/20/2024 and interviewed Staff #2 (S2) at 9:45 a.m., Family #1 (F1) at 10:30 a.m., and two (02) out of three (03) residents at 3:45 p.m., conducted a records review at 10:00 a.m., and toured the facility inside and out at 10:15 a.m. Today, LPA interviewed F1 again at 1:40 p.m., Resident #1 (R1) at 3:30 p.m., and staff #1 (S1) at 3:40 p.m., and toured the facility at 3:20 p.m.

Regarding the allegation “Staff member is physically abusing a resident” it was alleged S2 slapped R1. Interview with R1 at 4:00 p.m. on 03/20/24 revealed S2 slapped R1. No further details were provided about the time or place of the slap.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
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 2
Control Number 31-AS-20240315142734
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PEARL OF WEST HILLS, INC
FACILITY NUMBER: 197609889
VISIT DATE: 03/22/2024
NARRATIVE
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 Interview with S2 revealed they did not slap R1 and R1 was fabricating. Interview with Resident #2 (R2) at 3:50 p.m. on 03/20/2024 revealed they have not witnessed, heard, or experienced physical abuse in the facility. Interviews with F1 revealed R1 had difficulty distinguishing between delusions and reality. Interview with S1 confirmed S2 never slapped R1. Based on interviews, residents, family, and staff did not witness S2 slap R1 and cannot confirm if it did or did not happen. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff member is verbally abusing a resident” it was alleged S2 yelled at R1. Interview with R1 at 4:00 p.m. on 03/20/24 revealed S2 got angry and yelled at R1. No further details were provided. Interview with S2 revealed they did not yell at R1. Interview with R2 revealed they have not witnessed, heard, or experienced verbal abuse or yelling in the facility. Interviews with F1 revealed they were not aware of R1 being yelled at. Interview with S1 confirmed S2 did not and does not yell at R1. Based on interviews, residents, family, and staff did not witness or hear S2 yell at R1 and cannot confirm if it did or did not happen. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety risks were observed during this visit.

Exit interview conducted. Appeal rights discussed. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2