197610121-5-31-2024-31-AS-MVAO-D5WU5Y-20240604151732

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 05/30/2024
Date Signed: 05/31/2024 07:44:28 AM

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
06/14/2023 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20230614111602

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:	05/30/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Chris Salvador		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Resident was allowed to leave the facility unassisted resulting in injury

INVESTIGATION FINDINGS:

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On 5/30/2024 Licensing Program Analyst (LPA), Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth was met by the Administrator, Chris Salvador. LPA explained the purpose of this visit was to conduct interviews and present findings. LPA conducted a physical tour at 12:45 pm until 1:00 pm. LPA observed the facility was clean and did not observe any safety issues.
The investigation consisted of the following: On 06/21/2023, LPA Spaeth initiated a complaint investigation. LPA reviewed resident file and received copies of the documentation. LPA Spaeth also interviewed six residents. LPA Spaeth interviewed four staff members via phone call on 5/29/2024 at 3:00 pm until 4:00 pm.

Regarding the allegation, Resident was allowed to leave the facility unassisted resulting in injury, it is alleged that a resident (R1) was allowed to leave the facility unassisted and walked to the store. LPA Spaeth reviewed the Physician’s Report for R1 dated 03/31/2022. The report states R1 can leave the facility unassisted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024

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-20230614111602

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: 05/30/2024

NARRATIVE

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Also it is alleged that R1 fell two times walking to the store as of December, 2023 and sustained injuries. The first fall resulted in R1 having bruises on R1’s face. The second fall resulted in a passer by finding the resident on the ground and an ambulance called. Three out of twenty staff members were interviewed and stated R1 did not leave the facility during December, 2023 and R1 did not have any injuries during that month. The three staff stated if a resident is injured, an Incident Report is completed and the Administrator is notified. All three staff stated there is no incident report regarding R1 falling during December 2023.

The three staff members confirmed R1 would occasionally leave the facility to walk a few blocks to a grocery store to purchase a soda. On 2/24/2023, R1 left the facility between 10:30 pm and 10:45 pm. R1 did not sign out and did not inform staff R1 was leaving. S3 and S4 work the night shift and stated they check each residents’ rooms every two hours. At the 9:00 pm check, S3 and S4 observed R1 was asleep in R1’s room.

During the 11:00 pm check, S3 and S4 discovered R1 was not in bed. Both staff members checked the entire facility and did not find R1. S3 and S4 also stated they woke R1’s roommate (R2). R2 stated did not see R1 walk out of the room. The Administrator and another staff member (S1) were immediately contacted. S1 immediately drove to the facility and drove throughout the neighborhood searching for R1. Other staff members joined the search but R1 was not found. Staff members searched for R1 from 11:30 pm until 4:00 am. The Administrator confirmed they assisted with the search & confirmed staff followed protocol.

The local police department was contacted around 1:00 am and the local hospital was contacted but hospital staff confirmed R1 was not at the hospital. A staff member contacted another hospital and discovered R1 had been found by another source and was admitted to the hospital.

LPA interviewed six residents on 6/21/2023 from 12:00 pm until 1:00 pm. The six residents’ rooms are on the second floor and all confirmed they did not witness a resident leaving the facility the evening of 2/24/2023. LPA received copies of the residents’ Physician’s Report and observed the six residents (R2, R3, R4, R5, R6 and R7) are able to leave the facility unassisted. All six residents confirmed when leaving the facility, residents are asked to sign out and inform staff of their destination. R2, R3, R4, R5, R6 and R7 stated there has been no issues when leaving the facility.

Based upon LPA’s documentation review and interviews of staff and residents, the above allegation is unsubstantiated.

Exit interview conducted and a copy of the report was given.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024

LIC9099 (FAS) - (06/04)

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