197610121-1-17-2024-31-AS-NMAN-CZLRVL-20240118122144

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 01/17/2024
Date Signed: 01/17/2024 04:24:14 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
01/09/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240109152040

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: 49	DATE:	01/17/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Chris Salvador		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

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Facility staff are refusing to accept resident back after hospitalization
Facility staff are not returning resident's responsible parties' phone calls

INVESTIGATION FINDINGS:

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At 8:30 a.m. on 01/17/2024 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA interviewed Staff #1 (S1) at 8:45 a.m., Staff #2 (S2) at 9:00 a.m., Staff #3 (S3) at 9:15 a.m., Staff #4 (S4) at 9:45 a.m., Resident #1 (R1) at 10:15 a.m., and R1’s responsible party at 12:45 p.m., toured the facility at 10:00 a.m., and reviewed pertinent records including but not limited to physician’s reports, a face sheet, identification form, needs and service plan, and medical notes at 10:30 a.m. today.

Regarding the allegation “Facility staff are refusing to accept resident back after hospitalization” it was alleged the facility did not accept R1 back to the facility on 01/04/2024. Interview with S3 revealed R1 experienced a change of condition in the hospital.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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-20240109152040

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: 01/17/2024

NARRATIVE

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S2 notified the hospital on 01/04/24 and 01/05/24 that in order to remain in compliance with Title 22 regulations, the facility needed to arrange home health for R1 prior to readmitting them. S3 visited the hospital on 01/09/24 to reassess R1 and arrange for proper documentation and home health support. The hospital updated R1’s records, arranged for home health services, and discharged R1 on 01/12/24. Based on interviews and record review, the facility was unable to readmit R1 without updated documentation reflecting R1’s change of condition and home health services. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Facility staff are not returning resident's responsible parties' phone calls” it was alleged the facility did not inform R1’s responsible party of their change of condition. Interview with R1’s responsible party revealed they told the facility to send R1 to the hospital on 01/02/24. R1 was readmitted to the facility on 01/12/24. S3 spoke with R1’s responsible party on 01/04/24 and 01/05/24. The responsible party sent S3 an email at approximately 6:30 p.m. on 01/06/24. S4 sent the responsible party emails on 01/02/24, 01/03/24, 01/09/24 and 01/10/24. Based on interviews and record review, the facility properly informed R1’s responsible party of their condition via email. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety hazards were observed during this visit.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

LIC9099 (FAS) - (06/04)

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