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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609969
Report Date: 12/09/2024
Date Signed: 12/09/2024 07:12:34 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 Christine Yee
COMPLAINT CONTROL NUMBER: 29-AS-20231018081720
FACILITY NAME:VALLEY VISTA SENIOR LIVINGFACILITY NUMBER:
197609969
ADMINISTRATOR:WALTERS, STEPHANIEFACILITY TYPE:
740
ADDRESS:7040 VAN NUYS BLVDTELEPHONE:
(818) 906-4400
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:164CENSUS: 73DATE:
12/09/2024
UNANNOUNCEDTIME BEGAN:
10:54 AM
MET WITH:Elizabeth Whittington, Executive DirectorTIME COMPLETED:
07:15 PM
ALLEGATION(S):
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1. Due to lack of staff, resident calls are not answered timely
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA), Christine Yee, conducted a subsequent unannounced complaint visit to conduct additional investigation for the above allegation and met with Elizabeth Whittington, Executive Director. The reason for today's visit was explained.

On 10/23/23 Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and met with Elizabeth Whittington, Community Relations Director. Marissa Drinkhouse-Quintana, Administrator was not present in the facility. The reason for the visit was explained.

During the initial visit, LPA Yee reviewed and requested copies of facility documents, conducted face to face interviews with Staff #1 and Staff #2 at 11:50am, Resident #1 at 3:09pm, Resident #2 at 3:43pm and a telephone interview with Staff #3 at 1:42pm. Due to staff not having access to requested records and time
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
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 5
Control Number 29-AS-20231018081720
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: VALLEY VISTA SENIOR LIVING
FACILITY NUMBER: 197609969
VISIT DATE: 12/09/2024
NARRATIVE
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constraints, it was determined that additional investigation was needed to make a finding for the above allegation. Exit interview was conducted with Elizabeth Whittington and a copy of this report was provided.

On today's visit, LPA Yee conducted an interview with the Executive Director at 12:01pm, Resident #3 at 1:09pm, Resident #4 at 1:49pm and Resident #5 at 1:57pm. Facility documents were obtained at 1:53pm.

Per information obtained through interviews regarding allegation #1 - Due to lack of staff, resident calls are not answered timely, Residents interviewed when the complaint was initially received and on today's visit stated that they do not have any issues getting assistance but know of other residents who are kept waiting for long periods of time from the time they press their pendant to the time staff responds. Per interviews conducted when the complaint was initially filed on 10/18/23, the facility was having staffing issues during the night shift from 10pm - 6am. Staff were not calling in or reporting to work and one staff resigned. Staff scheduled to work from the employment agency were also not reporting to work. The Executive Director at the time that the complaint was files was also not on site often to oversee the operations of the facility and was aware that someone had called off on 10/17/23 and there was no backup coverage. The night shift in Assisted Living normally consists of a Medication Tech and a caregiver and 2 caregivers in Memory Care. As a result of the staff no call, no show on 10/17/23, the Medication Technician had to pitch in as a caregiver on the assisted living side of the facility, on top of their usual responsibilities. There was a total of 3 staff that night including the Medication Technician. Medication Tech did not request assistance from the 2 Memory Care staff as they had their own caseload. Attempts were made to reach the nurse for assistance and she could not be reached by telephone. Per review of the call for service logs, residents calls were not responded to in a timely on the night of 10/17/23 - 10/18/23. The longest response time was 47 minutes to room 406. Per review of the current call for service log from 11/16/24-11/30/24, the longest response time was 44 minutes to room 520 on 11/21/24. Based on the information obtained from interviews and review of facility records, there is sufficient evidence to support the allegation that due to lack of staff on 10/17/23, resident calls are not answered timely, therefore the allegation is substantiated at this time.

Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8.

Exit interview was conducted, Appeals Rights discussed and a copy was given.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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 Christine Yee
COMPLAINT CONTROL NUMBER: 29-AS-20231018081720

FACILITY NAME:VALLEY VISTA SENIOR LIVINGFACILITY NUMBER:
197609969
ADMINISTRATOR:WALTERS, STEPHANIEFACILITY TYPE:
740
ADDRESS:7040 VAN NUYS BLVDTELEPHONE:
(818) 906-4400
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:164CENSUS: 73DATE:
12/09/2024
UNANNOUNCEDTIME BEGAN:
10:54 AM
MET WITH:Elizabeth Whittington, Executive DirectorTIME COMPLETED:
07:15 PM
ALLEGATION(S):
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2. Facility is not providing a safe environment for the residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA), Christine Yee, conducted a subsequent unannounced complaint visit to conduct additional investigation for the above allegation and met with Elizabeth Whittington, Executive Director. The reason for today's visit was explained.

On 10/23/23 Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and met with Elizabeth Whittington, Community Relations Director. Marissa Drinkhouse-Quintana, Administrator was not present in the facility. The reason for the visit was explained.

During the initial visit, LPA Yee reviewed and requested copies of facility documents, conducted face to face interviews with Staff #1 and Staff #2 at 11:50am, Resident #1 at 3:09pm, Resident #2 at 3:43pm and a telephone interview with Staff #3 at 1:42pm. Due to staff not having access to requested records and time
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20231018081720
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: VALLEY VISTA SENIOR LIVING
FACILITY NUMBER: 197609969
VISIT DATE: 12/09/2024
NARRATIVE
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constraints, it was determined that additional investigation was needed to make a finding for the above allegation. Exit interview was conducted with Elizabeth Whittington and a copy of this report was provided.

On today's visit, LPA Yee conducted an interview with the Executive Director at 12:01pm, Resident #3 at 1:09pm, Resident #4 at 1:49pm and Resident #5 at 1:57pm. Facility documents were obtained at 1:53pm.

Per interviews conducted regarding Allegation #2 -Facility is not providing a safe environment for the residents, information revealed that two homeless individuals, a male and a female, were observed by a resident wandering around in the common area on the fourth floor of the facility at around 3:30am on 9/25/23. Resident notified staff. The facility is enclosed on all four sides and secured by fences and gates. Visitors enter the facility through the front lobby and are required to check in and out. The front desk is manned 24 hours a day. It is unknown how the 2 individuals entered the premises. It is hypothesized that they either climbed over the fence or that a staff left the gate ajar for re--entry instead of using their keys. The 2 individuals were walked out by staff once they were discovered. Per information received, this was the only incident where the homeless were on the premises. Based on the information received, there is insufficient evidence to support the allegation that the facility is not providing a safe environment for the residents, therefore the allegation is unsubstantiated.

Exit interview was conducted and copy of this report provided.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 29-AS-20231018081720
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: VALLEY VISTA SENIOR LIVING
FACILITY NUMBER: 197609969
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2024
Section Cited
CCR
87411(a)
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(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet residents’ needs.
This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above per
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The Licensee will review the needs of all the residents to ensure that the current staffing meets the needs of the residents and submit a written plan that will be implemented when staff call out to ensure that there is always staff coverage at all times by 12/16/24
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interviews conducted, it revealed there are times when only one caregiver is on duty in the Assisted Living side of the operation with 46 residents. This poses a potential health and safety risk for residents in care.
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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: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5