197610121-3-23-2023-31-AS-NMAN-CUTVTB-20230818164252

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 03/23/2023
Date Signed: 03/23/2023 12:59:23 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
12/27/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20221227105313

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):

1
2
3
4
5
6
7
8
9

Staff did not ensure resident received their mail while in care.
Staff do not ensure that food/drinks are of the quality necessary to meet the needs of the residents.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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 ensure resident received their mail while in care.

Regarding the allegation above, it was alleged Resident #1 (R1) did not receive their mail. LPA interviewed residents and staff on 12/29/2022 from 1:50 p.m. to 3:00 p.m. Staff and Director stated mail gets delivered to the front desk. It is then sorted into individual mailboxes. The mail is either delivered to residents, or residents pick up their mail at the front desk.

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)

Page: 1 of 2

Control Number 31-AS-20221227105313

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

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

R1 confirmed the mail is delivered to the front desk. The Director stated the facility has delivered all of R1’s mail to R1 directly. LPA conducted additional resident interviews on 03/23/2023 from 10:30 a.m to 11:30 a.m. Residents interviewed mentioned no issues in receiving mail. Based on interviews, there is insufficient evidence to prove the allegation occurred. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Staff do not ensure that food/drinks are of the quality necessary to meet the needs of the residents.

On 12/29/2022 LPA interviewed the Director at 2:40 p.m. and conducted a records review at 3:15 p.m. The Director stated the facility uses a certified dietitian to create a main and alternate menu to meet resident’s nutritional needs. During the record review, the Director provided sample menus as well as updates to the menu. On 03/23/2023 from 10:30 a.m. to 11:30 a.m. LPA interviewed residents. Residents stated they had no concerns about the quality of food provided. Based on interviews and record review, the allegation is deemed UNSUBSTANTIATED 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)

Page: 2 of 2