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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197610121
Report Date:
01/25/2022
Date Signed:
01/25/2022 02:26:12 PM
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
01/24/2022
and conducted by Evaluator
Wendell Smith
PUBLIC
COMPLAINT CONTROL NUMBER:
31-AS-20220124164627
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:
40
DATE:
01/25/2022
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Jonathan Millan
TIME COMPLETED:
01:35 PM
ALLEGATION(S):
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9
Residents are not provided snacks
Residents smoking in non-designated smoking areas of facility
INVESTIGATION FINDINGS:
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3
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9
10
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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit.
LPA conducted a physical plant tour of the facility to ensure no immediate health and safety issues from 9:30-10am.
Residents are not provided snacks
It is alleged that residents are not provided snacks on a regular basis. LPA conducted interviews with residents regarding this allegation from 10-11:30am. LPA also checked the kitchen for the ability to prepare and store food. Information obtained from interviews revealed that snacks are given out during evening medications and that are available upon request throughout the day. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/25/2022
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-20220124164627
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:
01/25/2022
NARRATIVE
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Residents smoking in non-designated smoking areas of facility
It is alleged that residents are smoking in their rooms and in non-designated smoking areas. LPA conducted interviews with residents from 10-11:30am regarding this allegation. LPA also during the physical plant tour observed three smoking designated areas in the facility. Information obtained from interviews revealed that there was an issue in the summer of 2021 of a resident smoking in their room but that the facility addressed it and it has stopped. Resident interviews reveal that there has been no issue with residents smoking in their rooms and the designated smoke areas have been used when residents smoke. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time.
Exit Interview conducted.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/25/2022
LIC9099
(FAS) - (06/04)
Page:
2
of
2