197610121-3-23-2023-31-AS-NMAN-CUTVWV-20230818164834

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 03/23/2023
Date Signed: 03/23/2023 01:00:52 PM

Substantiated

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
12/28/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20221228083700

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

Facility is in disrepair.

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.

Regarding the allegation above, it was alleged the fan in the bathroom of Resident #1 (R1) was broken. LPA and R1 inspected the fan on 12/29/2022 at 2:15 p.m. R1 turned the switch on and the fan did not operate. LPA interviewed R1 and the Director on 12/29/2022 from 1:50 p.m. to 3:00 p.m. R1 stated they did not report the issue to the facility. The Director confirmed no reports for maintenance were received. LPA informed the Director about the required maintenance at approximately 2:45 p.m. on 12/29/2022, and the Director immediately sent staff to fix the fan.

Substantiated

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 3

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
12/28/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20221228083700

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

Facility not providing adequate food service.

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.
Regarding the allegation above, it was alleged the facility did not offer sufficient snacks. LPA interviewed residents and staff on 03/02/2023 from 9:45 a.m. to 11:30 a.m. LPA conducted additional resident interviews on 03/23/2023 from 10:00 a.m. to 11:00 a.m. From interviews, staff stated snack are provided in the morning, afternoon, and night, usually with medication. The facility provides additional snacks upon request. Residents confirmed snacks are available in the morning and night. Based on interviews, the allegation is deemed UNSUBSTANTIATED at this time.
Exit interview conducted. Appeal rights discussed. Copy of report provided.

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: 2 of 3

Control Number 31-AS-20221228083700

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

LPA interviewed the Director again on 01/04/2023 at 1:45 p.m. He confirmed R1’s fan was fixed. LPA interviewed residents on 03/02/2023 from 9:45 a.m. to 11:30 a.m. and on 03/23/2023 from 10:00 a.m. to 11:00 a.m. Residents reported no issues requiring maintenance in their rooms or in the facility. Based on interviews and observations, although R1’s fan was observed to be inoperational, the facility provided maintenance in a timely manner upon discovering the issue. The fan did not pose an immediate or potential health, safety, or personal rights risk to residents. Therefore, the allegation is deemed SUBSTANTIATED at this time. A technical violation is issued, though no deficiency is issued.

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: 3 of 3