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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850091
Report Date: 11/13/2024
Date Signed: 11/13/2024 03:28:53 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
08/30/2024 and conducted by Evaluator Angela Barutyan
COMPLAINT CONTROL NUMBER: 29-AS-20240830143412
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:
11/13/2024
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Tony NunezTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility does not have enough staff to meet the needs of residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a second subsequent complaint investigation for the allegation listed above at 02:45PM. LPA met with Health and Services Director (HSD) Antonio “Tony” Nunez and Executive Director (ED) Susan Weisbarth and explained the reason for the visit.

During today's visit, LPA delivered final finding for the above allegation. During the subsequent visit which took place on 10/17/2024, LPA interviewed ED and HSD, reviewed and obtained copies of pertinent documents, conducted a brief physical plant tour, and interviewed two (2) residents and one (1) visitor. During the initial complaint visit which took place on 09/04/2024, LPAs Barutyan and K. Dulek reviewed records, conducted interviews, conducted a brief physical plant tour, conducted a medication review, and obtained copies of pertinent documents.
Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
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-20240830143412
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: PRESERVE AT WOODLAND HILLS, THE
FACILITY NUMBER: 195850091
VISIT DATE: 11/13/2024
NARRATIVE
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It was alleged that the facility has insufficient staffing. On 08/29/2024, LPA Barutyan conducted a visit for an unrelated complaint and observed one (1) caregiver, Staff #1 (S1) attending to around twenty-five (25) residents in the dining room. At 11:28AM during LPA’s physical plant tour on 08/29/2024, Resident #1 (R1) needed incontinence assistance and S1 left to assist R1 to the bathroom. LPA observed the remaining residents in the dining room left unassisted with no care staff. Staff #2, a kitchen staff member accompanying LPA on the tour, stated that it is like this “50% of the time” and that “residents get left alone, but it's never for too long.” S2 stated that he/she tries to stay in the dining room and watch the residents when he/she does not have to be in the kitchen, in order to help lighten the work load on care staff. S2 also stated that "the facility is very short-staffed, but the staff on shift are able to handle the load." S2 stayed behind to supervise staff until S1 returned around 20 minutes later. The complainant alleged that on 08/28/2024, only one (1) care staff was on shift after 7PM and on 08/24/2024, two (2) care staff were on shift from 2PM-10PM. LPA reviewed shift timestamp records which document four (4) staff on shift on 08/28/2024 after 7PM and three (3) staff on shift on 08/24/2024 between 2PM-10PM. There are two (2) residents who require two (2) person assists. Interviews conducted between 08/21/2024 – 09/04/2024 revealed nine (9) concerns of staffing numbers. One (1) caregiver on 08/21/2024, one (1) family member on 08/26/2024, one (1) staff member and four (4) family/responsible parties of residents on 08/29/2024, and two (2) family members on 09/04/2024 had concerns of the number of staff on shift. Although there were concerns of staffing, shift timestamp records from 08/11/2024 – 08/31/2024 document more than three (3) staff on shift at all times. Per regulation, there are no staffing ratios for residential care facilities for the elderly. California Code of Regulations, Title 22 Section 87415 Night Supervision states that “In facilities caring for sixteen (16) to one hundred (100) residents at least one employee shall be on duty on the premises, and awake. Another employee shall be on call, and capable of responding within ten minutes.” Furthermore, the facility has hired and onboarded one Health and Services Director, one Lifestyle Director, one Executive Director, one Business Operations Manager, one Resident Care Coordinator, six (6) caregivers, two (2) medication technicians, one Sous Chef, and one kitchen staff between 08/16/2024 – 11/13/2024. Record review of the current staff schedule reveals 3-4 care staff for the AM (6AM – 2PM) shift, 3-4 staff for the PM (2PM – 10PM) shift, and three (3) for the NOC (10PM – 6AM) shift. Based on record review, observation, and interviews, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may be valid, at this time there is insufficient evidence to support the allegation, therefore, the allegation “Facility does not have enough staff to meet the needs of residents in care” is deemed UNSUBSTANTIATED at this time. No citations issued. Exit interview conducted. Copy of the report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
LIC9099 (FAS) - (06/04)
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