197610121-3-23-2023-31-AS-NMAN-CV6K59-20230829073534

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 03/02/2023
Date Signed: 03/23/2023 01:03:43 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
02/28/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230228114452

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: 53	DATE:	03/02/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Chris Salvador		TIME COMPLETED:	12:12 PM

ALLEGATION(S):

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Facility is in disrepair
Staff do not ensure that residents are provided daily activities
Staff do not treat residents with dignity or respect
Staff are not providing agreed upon transportation service

INVESTIGATION FINDINGS:

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***This report was amended to change the findings of the allegation "Facility is in disrepair"****

At approximately 9:15 a.m. on 03/02/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and later the Administrator and disclosed the reason for the visit.

--- Facility is in disrepair ---

LPA interviewed staff and residents from 9:45 a.m. to 11:30 a.m. LPA conducted a records review at 9:55 a.m. and toured the physical plant at approximately 10:25 a.m. No immediate health or safety concerns were observed. Regarding the allegation above, it was alleged the facility did not have hot water for four days. From record review, the facility notified Community Care Licensing (CCL) of the maintenance via email.

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: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

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

Control Number 31-AS-20230228114452

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: 03/02/2023

NARRATIVE

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***This report was amended to change the findings of the allegation "Facility is in disrepair"****

In the afternoon of 02/24/2023, facility staff noticed intermittent losses of hot water. The Administrator noted that due to the cold and rainy weather, the main boiler was affected. The boiler was replaced after multiple efforts to repair it. SoCal Gas was called to the facility by 8:37 p.m. on 02/24/2023 and assessed the situation. By 11:46 p.m. that evening, the facility reported the problem to the Woodland Hills-South Regional Office. The facility scheduled 3 different appointments to fix the problem on the morning of 02/25/2023. The facility provided a second update at 12:01 a.m. on 02/27/2023. 3 out of 3 technicians were unable to fix the facility’s hot water, and 2 additional appointments for maintenance were scheduled for 02/26/2023. Caregivers notified residents of maintenance on the morning of 02/27/2023. A third email notified CCL that repairs were ineffective on 02/27/2023 and new boilers were ordered by 03/01/2023. From interviews, staff noted that residents were informed of the outage by intercom announcements, in-person notifications by caregivers, and a cold water notice form which some residents signed. Status updates were provided on 02/24/2023, 02/25/2023, 02/27/2023, and 03/01/2023. The facility accommodated residents by providing hot water from the kitchen and offering sponge baths. LPA tested the water temperatures during an annual inspection on 02/11/2023 and today at 11:20 a.m. The facility water temperatures were within regulations in both instances. Based on interviews, record review, and observations, resident faucets did not deliver sufficient hot water from the evening of 02/24/2023 – 03/01/2023, Therefore, the allegation is deemed SUBSTANTIATED at this time. However, the facility provided adequate accommodations and updates to residents, so no deficiency issued.

--- Staff do not ensure that residents are provided daily activities ---

Regarding the allegation above, it was alleged that some residents are left in the hallway all day without activities. From interviews, Resident #1 (R1) stated they spent most of their day in the hallway and they were comfortable doing so. Residents stated they were provided sufficient activities. The Activity Director stated more activities were formerly provided, but resident attendance was low. The Activity Director has varied activities offered to meet resident needs. From observations, LPA saw 4 residents performing morning exercises in the TV room around 9:30 a.m. and 5 residents attending Bible study around 10:30 a.m. LPA also observed daily and weekly activity schedules posted on the first and second floors. The activity room contained puzzles, board games, reading material, and art supplies. Based on interviews and observations, 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.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20230228114452

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: 03/02/2023

NARRATIVE

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***This report was amended to change the findings of the allegation "Facility is in disrepair"****

--- Staff do not treat residents with dignity or respect ---

Regarding the allegation above, it was alleged that staff do not treat residents respectfully. From interviews, residents felt treated with enough respect from staff. Staff noted disagreements occur from time to time, but they treat residents with dignity. Staff also mentioned they are mandated reporters to intervene and report any instances of disrespect. From observations of staff to resident interactions today, LPA observed staff consistently treat residents with respect. Based on interviews and observations, 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.

--- Staff are not providing agreed upon transportation service ---

Regarding the allegation above, it was alleged the facility van was broken and families were expected to transport residents. From interviews, staff noted the facility does not have a designated vehicle for transportation. Instead, the facility uses transportation services like Access and other program vehicles. Occasionally directors have driven residents to appointments as well. Residents reported no issues with transportation or requiring family for transportation needs. From record review, the facility 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”. 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: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC9099 (FAS) - (06/04)

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