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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801979
Report Date: 10/16/2024
Date Signed: 10/16/2024 05:02:56 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
06/20/2024 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20240620152856
FACILITY NAME:WELLNESS CARE SENIOR LIVINGFACILITY NUMBER:
565801979
ADMINISTRATOR:MARIA HERNANDEZFACILITY TYPE:
740
ADDRESS:158 ROCKAWAY ROADTELEPHONE:
(805) 649-5143
CITY:OAK VIEWSTATE: CAZIP CODE:
93022
CAPACITY:56CENSUS: 18DATE:
10/16/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria HernandezTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff is showering residents with cold water
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced subsequent complaint visit for the above allegation. The LPA arrived at 10:00 a.m., met with staff, and explained the reason for today's visit. Administrator Maria Hernandez arrived shortly after.

On 06/23/24, between 12:25 p.m. and 2:15 p.m., the LPA interviewed the Administrator, staff, residents, Individuals who were visiting residents and obtained copies of pertinent documents relevant to the investigation. On 10/14/24, the LPA along with the Administrator toured the facility, interviewed one (1) resident, and four (4) staff between 10:30 a.m and 4:00 p.m. During today's visit the LPA, toured the facility with the administrator, took the temperature of the hot water in eight (8) shower rooms, interviewed (6) staff, one (1) witness, two (2) residents and obtained copies of pertinent documents relevant to the investigation.

Report will continue on LIC9099-C (2nd page).
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: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
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 2
Control Number 29-AS-20240620152856
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: 10/16/2024
NARRATIVE
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On the allegation " Staff is showering residents with cold water"; it is the concern of the reporting party that Staff #1 (S1) showers residents with cold water. Ten (10) out of eleven (11) staff interviewed revealed that they have never observed or heard S1 or any staff shower residents with cold water. One (1) out of eleven (11) staff interviewed revealed that they have heard rumors that S1 has showered residents with cold water, however they have never witnessed it. S1 denied showering residents with cold water. Administrator Maria revealed that out of the eighteen (18) residents currently at the facility only five (5) residents get showered by staff, one (1) showers independently, and the remaining twelve (12) residents get showered by Hospice or a Home Health aide. Eight (8) residents interviewed did not voice any concerns regarding being showered with cold water. Interview with a residents family member revealed that they did not have any concerns regarding the residents shower. Based on interviews conducted with the administrator, staff, residents, and family member, there is insufficient evidence to support the allegation of “Staff is showering residents with cold water.” Therefore, this allegation in deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. Report was reviewed and a copy was issued to the Administrator.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2