197610121-1-31-2023-31-AS-NMAN-CZLTT3-20240118140002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 01/31/2023
Date Signed: 01/31/2023 05:20:46 PM

Unsubstantiated

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
12/21/2022 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20221221094559

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: 53	DATE:	01/31/2023
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Chris Salvador, Administrator		TIME COMPLETED:	05:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are allowing residents to smoke inside the facility.
Facility air conditioning is in disrepair.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Tihesha Smith made a subsequent unannounced complaint visit to this facility and met with administrator and explained the purpose of this visit.

During initial visit, on 12/22/2022, LPA Smith conducted tour of physical plant at 11:40 am, conducted interviews with administrators and requested documents relevant to the investigation.

Facility staff are allowing residents to smoke inside the facility.
At approximately 12:40 pm-3:00 pm LPA interviewed six (6) staff, five (5) residents conducted a physical plant tour and requested pertinent documents at 12:45 PM. LPA unable to interview Resident #1 (R1) due to time contraints.
LPA interview with five (5) out of five (5) residents revealed they have not smoked or seen any residents
(Cont to 809C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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-20221221094559

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: 01/31/2023

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

(Cont from 809)

smoking inside the facility. Resident #4 (R4) and Resident # 6 (R6) revealed guidelines about smoking in admissions agreement and smoking signs are posted. Resident #3 (R3) revealed that have not witnessed any residents smoking inside facility but revealed the smoke blows back inside from the windows near the smoking areas. Interview with Administrator revealed no residents are smoking inside facility. Administrator also revealed that all staff and residents are aware of house rules regarding smoking and each resident signs admission agreement containing smoking guidelines and information. LPA observed resident smoking in designated smoking area and reviewed admission agreement section 11.

Based on interviews and observation there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Facility air conditioning is in disrepair.
It was alleged that the facility air condition was in disrepair. On 12/22/2022 at 11:40 am LPA Smith conducted a tour at the facility. No disrepair was observed during inspection. The upstairs thermostat control in break room was in good repair, vents upstairs in common areas were blowing air. Interview with administrator revealed that there have not been any issues with the air conditioner. Interview with five (5) out of five (5) residents revealed no issue with air conditioning or heating system.

Based on interviews and observation there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

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

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2