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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850091
Report Date: 09/04/2024
Date Signed: 09/04/2024 04:47:06 PM

Unsubstantiated


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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/03/2024 and conducted by Evaluator Kelly Dulek
COMPLAINT CONTROL NUMBER: 29-AS-20240903124736
FACILITY NAME:PRESERVE AT WOODLAND HILLS, THEFACILITY NUMBER:
195850091
ADMINISTRATOR:MICHAEL OWENSFACILITY TYPE:
740
ADDRESS:6221 FALLBROOK AVENUETELEPHONE:
(747) 226-5834
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:60CENSUS: 35DATE:
09/04/2024
UNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Trevin WillisTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Resident was locked in room while in care
Staff did not provide resident with meals in a timely manner
Staff did not meet resident's care needs.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Angela Barutyan and Kelly Dulek arrived at the facility unannounced to conduct an initial complaint investigation for the allegations listed above at 09:38AM. LPAs met with staff and Executive Director (ED) Trevin Willis and explained the reason for the visit. Entrance interview conducted.

During today's visit, LPAs spoke with Administrator/ED at 09:40AM, spoke with Management company representative telephonically at 10:00AM, reviewed and obtained copies of pertinent documents, conducted a brief physical plant tour with ED at 10:55AM, observed lunch service at 12:11PM, observed medications for 5 (five) residents at 12:17PM, spoke with 3 (three) resident family members, and observed 5 (five) resident rooms/door locks beginning at 03:21PM. Previously, during unrelated visits at the facility, LPA Barutyan had conducted staff and family member interviews related to these complaint allegations. The following was then determined:

Report Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

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

DATE: 09/04/2024
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 3
Control Number 29-AS-20240903124736
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PRESERVE AT WOODLAND HILLS, THE
FACILITY NUMBER: 195850091
VISIT DATE: 09/04/2024
NARRATIVE
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Allegation: "resident was locked in room while in care:"
The complaint alleges that Resident #1 (R1) was left alone in their room while residing at the facility. LPAs reviewed R1's admission agreement as well as R1's needs and service appraisal. Upon admission, and up until R1 had a change of condition on 08/12/2024, R1 was able to ambulate and did not require assistance with mobility. During today's visit, LPA observed the door lock/closing mechanism on 5 different resident rooms, including that of R1. All door locks observed do have the option to remain unlocked at all times or a switch can be engaged which allows the door to remain locked from the outside, but the door will open when the handle is turned from the inside. There is also the option for a resident to engage a lock from the inside, which will not allow entry to the room, but again, the resident can turn the handle which disengages the lock, and a resident can exit the room. LPA confirmed that residents can exit their individual rooms at all times, without unlocking the door or requesting staff assistance. Interview revealed that residents can choose whether they remain in their room during the day, however, staff encourage all residents to leave their rooms and engage in facility activities. Based on interview and observation, although the allegation may be valid, at this time, there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation "resident was locked in room while in care" is deemed UNSUBSTANTIATED at this time.

Allegation: "Staff did not provide resident with meals in a timely manner:"
The complaint alleges that residents are waiting up to 2 hours for meals, which resulted in R1 losing a significant amount of weight. During today's visit and during a prior visit, LPAs observed meal service to residents. Additionally, interviews were conducted related to meals and meal service. Interview revealed that kitchen staff prepare the meals in the kitchen area, then deliver prepared food to the dining room. Lunch is served beginning at 12:00PM. Salad or soup is delivered first, then meals that are to be delivered to resident rooms are set up for care staff to deliver. One care staff is able to deliver the few meals to resident rooms, while the other care staff assist residents with their meals in the dining room. Kitchen staff then bring out the main course for care staff to serve. During today's visit, LPAs observed lunch at 12:07PM. All residents had been served the salad and about half had been served the main course at that time. Dining room staff were observed returning to the kitchen to deliver additional meals for the other residents. R1, who was named in the complaint, was able to ambulate to the dining room for all meals prior to a change in condition. R1 also had a log book in their room indicating their food and beverages eaten. On 09/03/2024, R1's doctor ordered NPO (nothing by mouth) as R1 is on hospice care, so R1's food could not be observed during today's visit. Additionally, R1 had been hospitalized as of 08/12/2024 following a medical incident. When R1 returned to the facility, R1 was placed on hospice care. As R1 had a change in condition, it is unclear whether the
Continued on LIC 9099-C
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

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

DATE: 09/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240903124736
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PRESERVE AT WOODLAND HILLS, THE
FACILITY NUMBER: 195850091
VISIT DATE: 09/04/2024
NARRATIVE
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weight loss was a result of the change in condition or whether there was insufficient food service. Based on interview, record review, and observation, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation "Staff did not provide resident with meals in a timely manner" is deemed UNSUBSTANTIATED at this time.

Allegation: "Staff did not meet resident's care needs:"
The complaint alleges that staff did not check on R1 timely while residing at the facility. Although interview with R1's family member revealed there was a verbal agreement indicating R1 would be checked every 30 minutes, review of R1's admission agreement revealed that there was no documented number of times staff would be checking on R1. During today's visit, LPA observed on the wall in R1's room a log indicating hourly checks for R1, which was completed in full for the September 2024 log. Staff interviewed indicate that all residents are encouraged to leave their rooms and engage in activities during the day and are therefore observed regularly. Staff indicated that residents who prefer to remain in their rooms are checked on based on their needs and service appraisal. Based on interview, record review, and observation, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore the allegation "staff did not meet resident's care needs" is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of today's report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

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

DATE: 09/04/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3