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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610151
Report Date: 07/19/2022
Date Signed: 07/19/2022 11:16:54 AM

Substantiated


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
07/14/2022 and conducted by Evaluator Patrick Shanahan
COMPLAINT CONTROL NUMBER: 31-AS-20220714091305
FACILITY NAME:AEGIS LIVING GRANADA HILLSFACILITY NUMBER:
197610151
ADMINISTRATOR:MATTHEW LA VINEFACILITY TYPE:
740
ADDRESS:10801 LINDLEY AVETELEPHONE:
(818) 363-3373
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:100CENSUS: DATE:
07/19/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Portia Blanco-Wellness NurseTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility has Cockroaches
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in response to the above allegation. The LPA was directed to a computer screen where the LPA's temperature was taken and all COVID questions were asked. LPA then made his way to the facility kitchen to investigate the allegation.

Allegation 1. Facility has Cockroaches
The LPA was able tour the facility kitchen. On the way to the kitchen, LPA observed that the kitchen staff was in the middle of a deep cleaning. LPA was able to interview the kitchen manager, who confirmed that they have been dealing with a cockroach infestation. The kitchen manager confirmed that on 7/12/2022, LA County Department of Health was at the facility and issued a violation for cockroaches in the kitchen. The kitchen manager confirmed that after the deep cleaning today, a pest control company will come tonight and conduct a deep spray for cockroaches.

Continues on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022
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 3
Control Number 31-AS-20220714091305
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: AEGIS LIVING GRANADA HILLS
FACILITY NUMBER: 197610151
VISIT DATE: 07/19/2022
NARRATIVE
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The facility administrator was also interviewed and confirmed that the facility was issued a violation from LA County Department of Health for cockroaches. The LPA did not observe any cockroaches on today's visit, however this allegation is considered to be Substantiated based on the findings on 7/12/2022.

Exit interview conducted, deficiency cited and report issued.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20220714091305
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: AEGIS LIVING GRANADA HILLS
FACILITY NUMBER: 197610151
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2022
Section Cited
CCR
80087(a)(1)
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Buildings and Grounds
The licensee shall take measures to keep the facility free of flies and other insects.
This requirement was not met as evidenced by:
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The facility was in the process of deep cleaning the kitchen and a pest control company has already been to the facility and will continue to treat the facility.

POC cleared before visit.
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Based on interviews conducted it was found that the facility had a cockroach infestation which could pose a potential health and safety risk to the clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3