197610121-6-26-2023-31-AS-MVAO-CUKSHL-20230810135345

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 06/26/2023
Date Signed: 06/26/2023 02:33:50 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
06/21/2023 and conducted by Evaluator Evelin Rios

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230621164128

FACILITY NAME:	WEST HILLS ASSISTED LIVING		FACILITY NUMBER:	197610121
ADMINISTRATOR:	GINGER PO		FACILITY TYPE:	740
ADDRESS:	7055 SHOUP AVENUE		TELEPHONE:	(818) 883-7201
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	90	CENSUS: 54	DATE:	06/26/2023
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Chris Salvador		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility does not provide residents transportation to medical appointment.

INVESTIGATION FINDINGS:

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On 06/26/2023 Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced complaint visit for the above allegation. LPA arrived at the facility at 10:05 a.m. and was greeted by staff #1(S1) at reception. S1 called the Director of Operation/Administrator Chris Salvador. LPA explained to Chris the purpose of the visit. Entrance interview conducted.

At 10:26 a.m. LPA and Chris conducted a physical plant tour to ensure the health and safety of the residents in care. No issues or concerns were observed. From 10:31 a.m. to 11:30 a.m. LPA interviewed at random six (6) out of fifty-four (54) residents. From 11:31 a.m. to 2:00 p.m. LPA reviewed resident records and obtained documents relevant to this investigation and reviewed the facility Program submitted to Community Care Licensing (CCL).
Allegation: Facility does not provide residents transportation to medical appointment.
It is alleged a resident has not been provided transportation to their medical appointments and that instead a family member of the resident has been providing transportation to medical appointments.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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-20230621164128

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WEST HILLS ASSISTED LIVING	FACILITY NUMBER: 197610121
	VISIT DATE: 06/26/2023

NARRATIVE

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Interview, with Chris revealed the facility does not have a designated vehicle for transportation. According to Chris, prior to the facility going through a change in ownership the facility did have a vehicle and actively transported residents to and from medical appointments. Since the change the facility encourages residents' family members to provide transportation to medical appointments and if family is unable to provide transportation the facility will arrange transportation through a third-party provider such as Access, Uber, taxi and other program vehicles at a cost to be covered by the resident or residents' insurance. Furthermore, according to Chris, as a last resort he has driven residents to medical appointments as well. Four (4) out of six (6) residents interviewed today reported no issues with obtaining or asking for transportation to medical appointments. Resident's that stated they have had family assist them with transportation needs noted it does not happen often and has not been an issue or concern. Record review revealed, the facility's admission agreement noted “the facility will arrange transportation through a third-party provider such as Access Para-Transit, Medical van, clinic shuttle, taxi, a family or friend”. Admission agreement Section 3 on Assistance in meeting necessary medical and dental needs, also noted, "we shall ensure that transportation is arranged if assistance is needed or desired by resident". Based on interviews and record review, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

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

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

LIC9099 (FAS) - (06/04)

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