197610121-1-4-2023-31-AS-NMAN-CUTW3G-20230818165555

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 01/04/2023
Date Signed: 01/04/2023 02:44:35 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
12/30/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20221230080630

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: 54	DATE:	01/04/2023
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Chris Salvador		TIME COMPLETED:	02:57 PM

ALLEGATION(S):

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Facility does not have a certified administrator
Staff mismanaged resident's funds

INVESTIGATION FINDINGS:

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At 1:35 p.m. on 01/04/2023 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the Administrator designee and disclosed the reason for the visit. LPA toured the facility and observed no immediate health or safety concerns.

LPA interviewed the Administrator designee at 1:45 p.m. and conducted another file review at 1:55 p.m.

Regarding the allegation “Facility does not have a certified administrator”, it was alleged the administrator designee served as the facility administrator duties without proper certification. From file review, the administrator designee was not listed in Community Care Licensing’s (CCL) list of pending and active Administrator certificate. The administrator designee did not have an active certificate. The designee explained that the licensees Ginger and Jeffrey Po maintained active administrator certificates. LPA confirmed this to be true from a 1:55 p.m. file review of the CCL website.

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: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

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-20221230080630

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: 01/04/2023

NARRATIVE

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The previous facility administrator was terminated on 07/12/2022, and the licensees submitted paperwork for the designee to serve as the administrator. LPA advised the licensees and designee to submit change of administrator paperwork to list licensees as facility administrators until the designee obtains their certificate. Based on file review and interviews, 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.

Regarding the allegation “Staff mismanaged resident's funds”, it was alleged Resident #1 (R1) did not receive their SSI funding. From interviews, R1 stated they have received a monthly check from social security and have not missed any payments. The administrator designee stated the facility does not handle resident funds. Based on interviews, 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: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

LIC9099 (FAS) - (06/04)

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