197610466-5-15-2024-31-AS-NMAN-D8XVSP-20240909164153

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610466
Report Date: 05/15/2024
Date Signed: 05/15/2024 11:57:16 AM

Substantiated

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
05/03/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240503095800

FACILITY NAME:	VALLEY SILVERTOWN		FACILITY NUMBER:	197610466
ADMINISTRATOR:	ODEN, STEPHANIE		FACILITY TYPE:	740
ADDRESS:	6833 FALLBROOK AVE		TELEPHONE:	(818) 883-4123
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	183	CENSUS: 40	DATE:	05/15/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Stephanie Oden		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Unassociated staff providing care
Staff sleeping while on duty

INVESTIGATION FINDINGS:

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At 8:30 a.m. on 05/15/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with the Executive Director (ED) and disclosed the reason for the visit.

To investigate the allegation above, LPA conducted an initial visit on 05/08/24 and interviewed the ED at 8:40 a.m., conducted a record review at 8:50 a.m., toured the facility at 9:00 a.m., and interviewed Resident #1 (R1) at 9:10 a.m. Today, LPA interviewed the ED, five (05) staff members, and four (04) out of forty (40) residents, which was 10% of the population between 8:35 a.m. and 11:00 a.m., conducted a record review at 10:30 a.m., and toured the facility at 10:45 a.m.

Regarding the allegation “Unassociated staff providing care” it was alleged S1 was working in the facility before obtaining a criminal background clearance. Interview with R1 revealed they saw S1 in the building in April 2024 and asked staff who S1 was. R1 was told that multiple staff were not aware of S1’s identity.

Substantiated

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: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

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 4

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
05/03/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240503095800

FACILITY NAME:	VALLEY SILVERTOWN		FACILITY NUMBER:	197610466
ADMINISTRATOR:	ODEN, STEPHANIE		FACILITY TYPE:	740
ADDRESS:	6833 FALLBROOK AVE		TELEPHONE:	(818) 883-4123
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	183	CENSUS: 40	DATE:	05/15/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Stephanie Oden		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff unhygienic at work, affecting resident personal rights

INVESTIGATION FINDINGS:

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At 8:30 a.m. on 05/15/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with the Executive Director (ED) and disclosed the reason for the visit. To investigate the allegation above, LPA conducted an initial visit on 05/08/24 and interviewed the ED at 8:40 a.m., conducted a record review at 8:50 a.m., toured the facility at 9:00 a.m., and interviewed Resident #1 (R1) at 9:10 a.m. Today, LPA interviewed the ED, five (05) staff members, and four (04) out of forty (40) residents, which was 10% of the population between 8:35 a.m. and 11:00 a.m., conducted a record review at 10:30 a.m., and toured the facility at 10:45 a.m. Regarding the allegation “Staff unhygienic at work, affecting resident personal rights” it was alleged staff were unhygienic at work which affected residents’ comfort. Interviews with four (04) out of four (04) residents, five (05) staff, and the ED between 8:35 a.m. and 10:50 a.m. today revealed no residents or staff had issues with staff hygiene. LPA observed no staff hygiene issues during the facility tour. Based on interviews and observations, staff come to work in a hygienic manner. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
No immediate health and safety risks were observed.Exit interview conducted. Copy of report provided.

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: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20240503095800

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: VALLEY SILVERTOWN	FACILITY NUMBER: 197610466
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/15/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/15/2024 Section Cited CCR 87355(e)(1)	1 2 3 4 5 6 7	87355 Criminal Record Clearance (e) All individuals subject to a criminal record review ... shall prior to working... in a licensed facility: (1) Obtain a California clearance... as required by the Department. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	On 05/06/24, the criminal record clearance of the staff member in violation was approved by the Department. Deficiency cleared.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not comply with the section citedd above in one (01) staff member which poses an immediate Health, Safety, or Personal Rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 31-AS-20240503095800

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: VALLEY SILVERTOWN	FACILITY NUMBER: 197610466
	VISIT DATE: 05/15/2024

NARRATIVE

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File review prior to the investigation revealed S1 received their criminal background clearance on 05/06/24. Record review revealed S1 began employment on 04/02/24. Interview with S1 at 11:00 a.m. today confirmed they started their employment around 04/02/24. Based on record review and interview, S1 began working at least 5 days prior to obtaining a criminal background clearance. Therefore, the allegation is deemed SUBSTANTIATED at this time. Deficiency is cited on the attached LIC 9099-D page. A civil penalty in the amount of $500 ($100 per day for 5 days, $100 x 5 = $500) is issued.

Regarding the allegation “Staff sleeping while on duty” it was alleged Staff #2 (S2) was asleep during their shift. Interview with Staff #3 (S3) at 10:00 a.m. today revealed S2 was recently fired for sleeping on the job. Interview with the ED at 10:15 a.m. today confirmed S2 was fired on 05/12/24 for sleeping on the job, however S2 was only in training at the time and was not in charge of caring for residents. The ED ensured sufficient care and supervision were provided to residents by qualified staff during S2's training. Record review today revealed S2 received a corrective action notice on 05/08/24 for sleeping on the job and was witnessed by two (02) staff members. LPA was unable to contact either of the two (02) staff witnesses. Based on interviews and record review, S2 was asleep during their shift. Since S2’s actions did not affect the residents in care, the allegation is deemed SUBSTANTIATED at this time and a Technical Violation is issued.

No immediate health and safety risks were observed.

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: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4