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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850111
Report Date: 04/17/2025
Date Signed: 04/17/2025 05:04:45 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
01/08/2025 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20250108110215
FACILITY NAME:LEXINGTON ASSISTED LIVINGFACILITY NUMBER:
565850111
ADMINISTRATOR:JILL MORRIS CHAPMANFACILITY TYPE:
740
ADDRESS:5440 RALSTON STTELEPHONE:
(805) 644-6710
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:125CENSUS: 60DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Jill Morris ChapmanTIME COMPLETED:
02:38 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff have not reassessed resident for change in level of care
Staff do not ensure facility carpeting is clean
Staff do not ensure facility elevator is maintained
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit regarding the above noted allegation. LPA met with Administrator Jill Morris Chapman and explained the reason for the visit.

At 10:35 a.m. LPA requested pertinent documents. At 10:55 a.m. LPA spoke with the maintenance director. At 11:00 a.m. LPA spoke with the administrator and reviewed documents. At 11:40 a.m. LPA and Administrator attempted to locate Resident 1 (R1) at the facility, however R1 left for a walk and was not going to be back for an extended time. At 12:05 p.m. Administrator texted R1 who responded the complaint "was a mistake based on a misunderstanding." R1 stated after meeting with the Administrator and Long Term Care Ombudsman everything was clarified and R1 does not wish to pursue this complaint.

Based on this information, the above noted allegations are deemed Unsubstantiated at this time. Exit interview conducted and report issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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