197610121-12-19-2024-31-AS-NMAN-DEATBG-20250227133509

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 12/19/2024
Date Signed: 12/19/2024 04:31:58 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
12/13/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20241213164110

FACILITY NAME:	WEST HILLS ASSISTED LIVING		FACILITY NUMBER:	197610121
ADMINISTRATOR:	EDGARDO GALANG		FACILITY TYPE:	740
ADDRESS:	7055 SHOUP AVENUE		TELEPHONE:	(818) 883-7201
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	90	CENSUS: 56	DATE:	12/19/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ed Galang and Chris Salvador		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Resident escaped from the facility due to lack of supervision

INVESTIGATION FINDINGS:

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At approximately 10:00 a.m. on 12/19/24 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.

To investigate the allegation above, LPA toured the facility inside and out at 10:00 a.m., interviewed staff, a resident, and a representative between 10:05 a.m. and 10:45 a.m. today, and conducted a record review of pertinent records at 11:00 a.m., including but not limited to medical assessments, a care plan, and hospital discharge paperwork.

Regarding the allegation "Resident escaped from the facility due to lack of supervision" it was alleged Resident #1 (R1) had an unsupervised fall on the street out of the facility. Record review of R1’s medical assessment revealed they were ambulatory, capable of leaving the facility unassisted, and had no cognitive impairment.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

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-20241213164110

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: 12/19/2024

NARRATIVE

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Interview with R1 at 10:15 a.m. today revealed they walk outside almost every day without assistance, as they prefer. R1 noted they recently developed balance issues. R1 recalled that they had lost their balance and fallen outside of the facility, but R1 sustained no bruises or injuries from the fall. Interview with the administrator at 10:30 a.m. today confirmed R1 walks outside almost every day and does not require supervision. The administrator further noted that the facility has been working with R1 and their representative to arrange medical care necessary to fix R1’s balance issues. Interview with R1’s representative at 10:50 a.m. today confirmed the facility has sufficiently provided care and supervision in the facility for R1 and has assisted R1 in arranging medical appointments to fix their balance issues. Based on interviews and record review, the resident did not require supervision outside of the facility and was able to leave unassisted. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

LIC9099 (FAS) - (06/04)

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