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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801979
Report Date: 04/09/2024
Date Signed: 04/09/2024 04:54:10 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2022 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20220504134133
FACILITY NAME:WELLNESS CARE SENIOR LIVINGFACILITY NUMBER:
565801979
ADMINISTRATOR:ALEIDA ALONSOFACILITY TYPE:
740
ADDRESS:158 ROCKAWAY ROADTELEPHONE:
(805) 649-5143
CITY:OAK VIEWSTATE: CAZIP CODE:
93022
CAPACITY:56CENSUS: 26DATE:
04/09/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Maria HernandezTIME COMPLETED:
04:55 PM
ALLEGATION(S):
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Staff are not following resident's special diet
INVESTIGATION FINDINGS:
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At 10:30 a.m. Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent unannounced complaint inspection at the facility today. The LPA met with Administrator Maria Hernandez and explained the reason for today's inspection.

On 5/12/22, LPAs Rosales and Lopez conducted a physical plant tour with the Administrator beginning at 11:00 a.m., conducted interviews with facility staff and residents between 12:44 p.m. and 4:49 p.m., and at 3:50 p.m., the LPAs also began record review. On 3/15/24, between 10:45 a.m. and 4:00 p.m., LPA Cortez interviewed the Administrator, staff, residents, two (2) Individuals, conducted a file review, and obtained copies of resident records and other pertinent documents relevant to the investigation. During todays visit, between 10:30 a.m. and 4:45 p.m. LPA Cortez interviewed one (1) resident, two (2) staff, conducted file review and obtained copies of pertinent documents.

Report will continue on LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
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
Control Number 29-AS-20220504134133
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: WELLNESS CARE SENIOR LIVING
FACILITY NUMBER: 565801979
VISIT DATE: 04/09/2024
NARRATIVE
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Regarding the allegation: Staff are not following resident's special diet; it is the reporting party’s concern that several residents need blended foods, and one resident (R1) needs organic foods, and another resident (R2) is allergic to onions, but staff are not following any of their diets. To investigate the complaint the LPA conducted a tour of the kitchen, conducted staff and resident interviews, and conducted a file review. On 03/15/24 at 12:00 p.m. LPA Cortez observed kitchen staff preparing lunch based on menu #1 and observed a variety of plates being prepared which included pureed meals, a sandwich meal, and the meal based on their Menu for the day. At 12:05 p.m. the LPA also observed a resident eating food provided by their family. Staff interviews revealed that kitchen staff were alerted to resident’s special diets as they are posted in the kitchen. In addition, staff interviews revealed that they try to also be mindful to the residents likes and dislikes, they try to accommodate the residents, if they do not like the food that is being prepared for the day. Staff interviews revealed that R2 has stated they are allergic to onions, however they have confirmed with R2’s family that they do not have an allergy to onions, and it is a preference. File review revealed that R1 and R2 did not have a special diet or allergies noted on their most recent Physicians Report (LIC602) dated 10/05/22 and 5/26/23. However, LPA advised Administrator to review R2's file as R2 had an onion allergy noted on a past LIC602. File review further revealed that R1 would buy their own organic food. Based on the information gathered, although the allegation may be valid, the Department does not have sufficient evidence to support the allegation that “Staff are not following resident's special diet”. Therefore, this allegation is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC9099 (FAS) - (06/04)
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