197610121-3-23-2023-31-AS-NMAN-CUHV4X-20230808160703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 03/23/2023
Date Signed: 03/23/2023 12:58:24 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/26/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20220726164145

FACILITY NAME:	WEST HILLS ASSISTED LIVING		FACILITY NUMBER:	197610121
ADMINISTRATOR:	MILLAN, JONATHAN		FACILITY TYPE:	740
ADDRESS:	7055 SHOUP AVENUE		TELEPHONE:	(818) 883-7201
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	90	CENSUS: 53	DATE:	03/23/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Mike Dy		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not refill resident’s medication on time
Staff did not respond to resident's call button
Staff sleeping during working hours

INVESTIGATION FINDINGS:

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At 9:00 a.m. on 03/23/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with a facility representative and disclosed the reason for the visit. At 9:10 a.m. LPA toured the facility and observed no immediate health or safety concerns. At 10:10 a.m. LPA spoke with the Administrator on the phone. The Administrator stated the facility representative could sign licensing documents in their absence.

Staff did not refill resident’s medication on time

Regarding the allegation above, it was alleged Resident #1 (R1) did not have their medication refilled before it ran out. LPA conducted a records review on 10/26/22 at 2:30 p.m. Facility documents revealed that R1’s medication arrived on the scheduled day. LPA interviewed facility Director on 08/02/2022 around 10:45 a.m., a facility med tech on 08/02/2022 at 12:43 p.m., and R1’s doctor and pharmacy technician on 10/14/2022 from 3:30 p.m. to 4:30 p.m.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

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 31-AS-20220726164145

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WEST HILLS ASSISTED LIVING	FACILITY NUMBER: 197610121
	VISIT DATE: 03/23/2023

NARRATIVE

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From interviews, medications were ordered in a timely manner, and the facility maintained an adequate supply of medications for R1. Based on record review and interviews, the allegation is deemed UNSUBSTANTIATED at this time.

Staff did not respond to resident's call button

Regarding the allegation above, it was alleged Staff #1 (S1) did not respond to R1’s call button. S1 was unavailable for interview. LPA interviewed the available night staff, Staff #2 (S2), on12/29/2022 at 7:15 a.m. S2 stated the night shift work in pairs and attend to resident call buttons and provide medications. S2 did not recall the specific incident. LPA interviewed other staff on 08/02/2022 from 10:30 a.m. to 12:30 p.m. Staff stated they respond to resident call buttons promptly and have had no issues with the call system. At 1:30 p.m. on 08/02/2022 R1 and LPA tested their call button in their room, and staff responded within approximately two minutes. Based on interviews and observations, although the allegation may have happened, there is insufficient evidence to prove the alleged violation occurred. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Staff sleeping during working hours

Regarding the allegation above, it was alleged S1 was found sleeping while working. S1 was unavailable for interview. From interviews, S2 stated they occasionally nap on their breaks but never while working. Staff ensure adequate coverage is provided. Other staff interviewed on 08/02/2022 from 10:30 a.m. to 12:30 p.m. stated they do not nap at work. The Administrator confirmed the night staff work in pairs to ensure resident needs are met. Based on interviews, there is insufficient evidence to prove the alleged violation occurred. Therefore, the allegation is deemed UNSUBSTANIATED at this time.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC9099 (FAS) - (06/04)

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