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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850240
Report Date: 11/26/2024
Date Signed: 11/26/2024 04:45:20 PM

Document Has Been Signed on 11/26/2024 04:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:VARIEL OF WOODLAND HILLS, THEFACILITY NUMBER:
195850240
ADMINISTRATOR/
DIRECTOR:
JOYCE AQUINOFACILITY TYPE:
740
ADDRESS:6233 VARIEL AVETELEPHONE:
(818) 651-6018
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 436CENSUS: 352DATE:
11/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Jessica SaksTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Angela Barutyan conducted an unannounced case management - incident visit at 02:10PM. Upon arrival, LPA met with staff and Director of Nursing (DN) Jessica Saks. Reason for the visit was explained.

On 10/31/2024, the Department received an incident report stating that on 10/30/2024, the facility was made aware of fraudulent activity from a staff member toward Resident #1 (R1). The SOC 341 reports that two (2) personal checks were made out from R1’s account to Staff #1 (S1) for “service pay” in the amounts of $3000 and $5000. S1 has since been terminated. The facility cross-reported to Adult Protective Services, the Long-Term Care Ombudsman, and Law Enforcement.

During today’s visit, LPA conducted a brief physical plant tour, conducted interviews with DN Saks at 02:35PM, two (2) staff members, and eight (8) residents between 03:20PM - 04:30PM, and reviewed and obtained copies of pertinent documents relevant to the investigation.

Prior to issuing final licensing report, it has been determined that further investigation is needed at this time.



Exit Interview Conducted and Report was Issued.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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