197610121-11-2-2023-31-AS-NMAN-D6LRUF-20240626131951

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 11/02/2023
Date Signed: 11/02/2023 01:58:06 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
10/31/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20231031144549

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: 50	DATE:	11/02/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Ed Galang		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are unlawfully evicting resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

At 11:00 a.m. on 11/02/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the Administrator and Director and disclosed the reason for the visit.

Regarding the allegation “Staff are unlawfully evicting resident”, it was alleged the eviction Resident #1 (R1) was unlawful and R1 did not receive an eviction notice.\

To investigate the allegation above, LPA conducted a file review at 9:45 a.m. today, interviewed staff between 11:00 a.m. and 12:00 p.m., and toured the facility at 11:45 a.m. No immediate health or safety hazards were noted during the time of this visit.

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: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

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-20231031144549

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: 11/02/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

File review prior to today’s investigation at 9:45 a.m. today revealed the facility had documented and informed the Community Care Licensing Division of several instances between 04/10/2023 and 09/27/2023 of R1 failing to follow the facility’s House Rules. Interview with the Administrator today at 11:00 a.m. revealed that a meeting was held on 09/27/2023 with R1 and an eviction notice was provided along with the reason for eviction. Interview with the Director at 11:15 a.m. today revealed the Director, Administrator, and facility staff have witnessed R1's failure to follow the house rules since April 2023. Reasons for the eviction were stated on the notice. R1 confirmed via phone call at 3:45 p.m. on 10/31/2023 that they did receive the eviction notice. R1 denied the reasons for the eviction ever occurred. Based on file review and interviews, the facility was compliant with Title 22 regulations in issuing R1’s eviction, and there is insufficient evidence to verify the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

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: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2