<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610043
Report Date: 12/17/2024
Date Signed: 12/17/2024 01:07:19 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
10/28/2024 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20241028155908
FACILITY NAME:MEGAN'S PLACEFACILITY NUMBER:
197610043
ADMINISTRATOR:OSBORN, ANNIEFACILITY TYPE:
740
ADDRESS:7708 ETHEL AVENUETELEPHONE:
(818) 853-7654
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: DATE:
12/17/2024
UNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Annie OsborneTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not seek timely medical care for resident
Unlawful Eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Trevor Byrne conducted a complaint visit for the above allegations. LPA arrived to the facility at 10:53 AM. LPA met with facility staff who contacted the facility Administrator Annie Osborn. The Administrator arrived to the facility at approximately 12:11 PM. Entrance interview conducted and the reason for the visit was explained.

During the initial visit on 11/01/2024, the LPA conducted a physical plant tour to ensure there are no health and safety hazards, conducted interviews with the Administrator, two (2) staff members, two (2) residents, one (1) witness and obtained copies of documents pertinent to the investigation between 09:06 AM and 12:09 PM. During today’s visit between 10:53 AM and 12:15 PM, LPA conducted a brief physical plant tour and interviewed the facility Administrator and the hospice company that treated Resident #1.

Continued on LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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 6
Control Number 29-AS-20241028155908
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: MEGAN'S PLACE
FACILITY NUMBER: 197610043
VISIT DATE: 12/17/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The allegation of “Facility staff did not seek timely medical care for resident” alleges that facility staff did not seek timely medical care for R1’s facial wound. During the 11/01/2024 visit LPA Byrne interviewed S1. S1 stated that they noticed the wound on R1’s face bleeding through the bandage on 10/15/2024, the day that the Resident arrived to the facility. S1 immediately informed the facility Administrator of the resident’s wound. During the interview with the Administrator, they stated that R1 was first seen by a hospital on 10/18/2024. When asked why there was a delay in seeking treatment the Administrator stated that R1 was doing okay, they thought they could take care of the wound. The interview with W1 confirmed that R1 was first hospitalized on 10/18/2024 and returned to the facility later in the evening on the same day. Based on the information obtained during interviews there is sufficient evidence to support the allegation that facility staff did not seek timely medical care for resident. Therefore, the allegation is deemed Substantiated at this time.

The allegation of “Unlawful Eviction” alleges that the facility did not follow proper eviction procedures for the eviction of R1. During the 11/01/2024 visit LPA Byrne interviewed the facility Administrator. The Administrator stated that during the time R1 resided at the facility they had not signed an admission agreement. The Administrator stated that R1 was sent to the hospital on 10/24/2024 and did not return to the facility. The interview with W1 revealed that on 10/24/2024 they were present at the facility when paramedics arrived to transport R1. W1 stated that the Administrator plainly told them that R1 could no longer stay at the facility due to being a liability. W1 stated that, “Without a question she was evicted.” LPA Byrne reviewed the facility file and confirmed that no eviction notice was submitted to the regional office regarding R1. Based on the information obtained during interviews and file review there is sufficient evidence to support the allegation of unlawful eviction. Therefore, the allegation is deemed Substantiated at this time.

The following deficiencies were cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20241028155908
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: MEGAN'S PLACE
FACILITY NUMBER: 197610043
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/31/2024
Section Cited
CCR
87224(a)
1
2
3
4
5
6
7
87224 Eviction Procedures
(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required...
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The licensee will submit a statement of understanding to CCLD confirming that they have read the entirety of CCR 87224 and understand the importance of following proper eviction procedures.
8
9
10
11
12
13
14
Based on interview and record review the licensee did not comply with the section cited above as a lawful eviction for R1 was not submitted to CCLD prior to the resident's eviction from the facility which posed a potential personal rights risk to clients in care.
8
9
10
11
12
13
14
Type B
12/31/2024
Section Cited
CCR
87465(a)(1)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care
(a) A plan for incidental medical and dental care shall...
(1) The licensee shall arrange...for medical and dental care appropriate to the conditions and needs of residents.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The licensee will submit a statement of understanding to CCLD confirming that they have read the entirety of CCR 87645 and understand the importance of seeking medical care for residents in a timely manner.
8
9
10
11
12
13
14
Based on interview the licensee did not comply with the section cited above as medical care for R1's facial wound was sought 3 days after first being identified which posed a potential health risk to clients in care.
8
9
10
11
12
13
14
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: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
10/28/2024 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20241028155908

FACILITY NAME:MEGAN'S PLACEFACILITY NUMBER:
197610043
ADMINISTRATOR:OSBORN, ANNIEFACILITY TYPE:
740
ADDRESS:7708 ETHEL AVENUETELEPHONE:
(818) 853-7654
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: DATE:
12/17/2024
UNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Annie OsborneTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained unexplained facial wounds
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Trevor Byrne conducted a complaint visit for the above allegation. LPA arrived to the facility at 10:53 AM. LPA met with facility staff who contacted the facility Administrator Annie Osborn. The Administrator arrived to the facility at 12:11 PM. Entrance interview conducted and the reason for the visit was explained.

During the initial visit on 11/01/2024, the LPA conducted a physical plant tour to ensure there are no health and safety hazards, conducted interviews with the Administrator, two (2) staff members, two (2) residents, one (1) witness and obtained copies of documents pertinent to the investigation between 09:06 AM and 12:09 PM. During today’s visit between 10:53 AM and 12:15 PM, LPA conducted a brief physical plant tour and interviewed the facility Administrator and the hospice company that treated Resident #1.

Continued on LIC 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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 6
Control Number 29-AS-20241028155908
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: MEGAN'S PLACE
FACILITY NUMBER: 197610043
VISIT DATE: 12/17/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The allegation of “Resident sustained unexplained facial wounds” alleges that Resident #1 (R1) sustained an unexplained facial wound while in the facility’s care. During the initial visit on 11/01/2024 LPA interviewed the facility Administrator. The Administrator stated that the resident arrived to the facility with a wound present on their face, this was corroborated by an interview with a family member of R1 (W1) who stated that the wound on R1’s face was present prior to their acceptance into the facility. An interview with Staff #1 (S1) revealed that they observed the wound on R1’s face the day they arrived to the facility and immediately informed the Administrator. Based on the information obtained during interviews there is not sufficient evidence to support the allegation of resident sustained unexplained facial wounds. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. Report was reviewed and a copy was provided.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6