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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 08/13/2024
Date Signed: 08/13/2024 04:16:16 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
08/09/2024 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20240809155427
FACILITY NAME:WEST HILLS ASSISTED LIVINGFACILITY NUMBER:
197610121
ADMINISTRATOR:GINGER POFACILITY TYPE:
740
ADDRESS:7055 SHOUP AVENUETELEPHONE:
(818) 883-7201
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:90CENSUS: 58DATE:
08/13/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Chris SalvadorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Illegal eviction
INVESTIGATION FINDINGS:
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At approximately 9:00 a.m. on 08/13/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint inspection. LPA met with the administrator and disclosed the reason for the visit.

To investigate the allegation above, LPA interviewed staff at 9:30 a.m. and 9:40 a.m., toured the facility at 10:00 a.m., and conducted a records review of documents pertinent to the investigation, including but not limited to a medical assessment, service plan, and identification form.

Regarding the allegation “Illegal eviction” it was alleged Resident #1 (R1) was ready to return to the facility from the hospital, and facility staff did not allow R1 to return. Interview with Staff #1 (S1) revealed they visited R1 at the hospital on 08/07/24 to reassess their needs and ensure they were suitable for readmission to the facility. It was discovered that R1 had contracted a communicable disease which was potentially infectious to other residents. Therefore, the facility did not readmit R1 at that time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
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-20240809155427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WEST HILLS ASSISTED LIVING
FACILITY NUMBER: 197610121
VISIT DATE: 08/13/2024
NARRATIVE
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Interview with the hospital staff at 3:10 p.m. today confirmed that R1 was not ready for discharge when S1 visited and the hospital would provide care for R1 until their infectious period had passed. Interview with S2 confirmed that the facility designated a room for quarantine after R1’s return to ensure the health and safety of all facility residents.

Based on interviews and record review, the facility did not evict R1 but instead waited for R1 to become suitable for readmission. Therefore, the allegation is deemed UNSUBSTANTIATED at this time,

No immediate health and safety risks were observed during today’s visit.

Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2