197610121-7-28-2023-31-AS-RRAZ-CWDNN7-20231007103616

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 07/28/2023
Date Signed: 07/28/2023 02:27:55 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
07/21/2023 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20230721144737

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: 55	DATE:	07/28/2023
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Chris Salvador, Mike Dy		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff do not maintain facility in good repair.
Staff are not meeting resident's need for clean linens.
Staff are not meeting resident's incontinence care needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with the administrator, Chris Salvador, and care coordinator, Mike Dy, and advised them of the complaint. Today's investigation consisted of interviews with residents and staff, and a physical plant inspection, which were conducted between 9:15am to 11:15am. A record review between 11:15am and 12:30pm was also made.

Staff do not maintain facility in good repair:
In regards to the allegation, it was reported that Resident 1's (R1) room is really hot. Room temperature is not maintained in a comfortable level. R1 has asked for a change of the air conditioning (AC) unit because the AC in their room is very old and does not work properly. During the course of the investigation, LPA conducted a physical plant inspection. The building is two stories. LPA inspected five (5) of five (5) resident rooms on the first floor, and five (5) of five (5) resident rooms on the second floor, totalling ten rooms.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

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-20230721144737

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: 07/28/2023

NARRATIVE

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Per observation, all ten rooms appeared to be maintained at a comfortable temperature, ranging between 70 to 75 degrees. In addition, LPA spoke with ten (10) of ten (10) residents, who stated the air conditioning unit in their room is functional. These residents expressed no complaints about the use of their air conditioning unit during extreme heat, as their AC unit works good. Per interviews with the administrator and care coordinator, each resident room has their own AC unit installed on the wall for the resident to adjust the temperature as they please. Only the hallways, conference room, and common areas have central air. Both administrator and care coordinator stated that if one AC unit breaks down, it gets replaced almost immediately. As a precaution, because of extreme temperatures during the summer, the licensee had been proactive and purchased approximately ten (10) new AC units, which are reserved in storage, in case a resident's AC unit breaks down. LPA observed these reserved units in storage, and also obtained a copy of the invoice as they have recently been purchased on 06/28/23. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff not maintaining facility in good repair. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff are not meeting resident's need for clean linens:
In regards to the allegation, it was reported that R1 does not receive sheets but once a week. During the course of the investigation, LPA conducted a physical plant inspection. The building is two stories. LPA inspected five (5) of five (5) resident rooms on the first floor, and five (5) of five (5) resident rooms on the second floor, totalling ten rooms and observed clean fresh linens that had just been serviced by housekeeping. In addition, LPA spoke with ten (10) of ten (10) residents, who expressed no complaints about not getting clean linens. These residents confirmed that housekeeping changes their sheets once per week, or sometimes, as needed. Per interviews with the administrator, care coordinator and one (1) of one (1) housekeeping staff, linens and towels are changed once per week or as needed due to incontinence issues that can occur at times. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff not meeting resident needs for clean linen. There fore the allegation is deemed Unsubstantiated at this time.

Staff are not meeting resident's incontinence care needs.
In regards to the allegation, it was reported that R1 does not receive diapers. Interview with the administrator and care coordinator deny the allegation. According to both, R1's insurance covers their incontinent needs. R1 is also in the Assisted Living Waiver (ALW) which funds their incontinent products. R1 also wants a specific brand of diaper, which R1's family helps supplement in purchasing. Interview with R1 confirm

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20230721144737

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: 07/28/2023

NARRATIVE

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that their needs for incontinent care and diapers are met. LPA also interviewed R1's family, who confirm that R1's needs for incontinent care and diapers are also being met. R1's family expressed no complaints or concerns with facility regarding the care and services provided to R1, and is satisfied with the care and supervision provided by facility staff. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff not meeting R1's incontinent care. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

LIC9099 (FAS) - (06/04)

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