<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850240
Report Date: 12/12/2024
Date Signed: 12/12/2024 05:38:30 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
08/09/2023 and conducted by Evaluator Christine Yee
COMPLAINT CONTROL NUMBER: 29-AS-20230809144351
FACILITY NAME:VARIEL OF WOODLAND HILLS, THEFACILITY NUMBER:
195850240
ADMINISTRATOR:JOYCE AQUINOFACILITY TYPE:
740
ADDRESS:6233 VARIEL AVETELEPHONE:
(818) 651-6018
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:436CENSUS: 352DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
12:04 AM
MET WITH:Jessica Saks, Director of NursingTIME COMPLETED:
05:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
1. Staff did not evacuate resident during a fire
2. Staff not properly trained for fire evacuation.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst(LPA), Christine Yee conducted a subsequent unannounced complaint visit to conduct additional investigation and to deliver the findings of the above allegations. LPA Yee met with Jessica Saks, Director of Nursing and the reason for the visit was provided.

An initial visit was conducted on 8/10/23 and facility documents were requested beginning at 12:05pm, facility records were reviewed at 1:24pm, interviews were conducted with Jessica Saks at 1:00pm and Jim Biggs at 2:31pm. Due to time constraints, residents could not be interviewed. Per information obtained on today's visit, further investigation is needed to make a finding for the above allegations. Exit interview was conducted.

On today's visit, LPA Yee obtained additional facility documents throughout the visit, conducted an interview with Jessica Saks at 12:21pm and interviewed Residents #1 at 1:28pm.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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-20230809144351
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: VARIEL OF WOODLAND HILLS, THE
FACILITY NUMBER: 195850240
VISIT DATE: 12/12/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Per information received from interviews and review of facility records regarding Allegation #1 - Staff did not evacuate resident during a fire, on 8/8/23 the facility had a small kitchen fire sparked off by the vendor hired by the facility to extend the gas line in the kitchen for an additional fryer. The vendor did not turn off the gas before working on the gas line extension and the fire was sparked by the nearby stoves. The kitchen fire activated the sprinkler and Ansul system and the fire was immediately put out before the fire department arrived.

Per information provided, the intercom system was also activated and residents were told to stay in their rooms until they are given different instructions. This information is also noted on the Resident Guide given to all the residents as part of their welcome package when they move in. Per review of the Resident Guide, the guide provides residents with information about the Community, Safety and Emergencies and Health Services. Under the Safety and Emergencies Section, Residents are advised to stay in place unless they are told differently. No resident evacuation protocol was activated on 8/8/23. Per interview conducted with Resident #1, they confirm that they were instructed to stay in place but they came down to enquire about evacuation plans for Resident #2 who uses a walker. Per Resident #1, they were aware that Resident #2 was never in danger and no staff told them that they did not know what to do. Per Resident #1, they did run into a staff who looked confused and this staff informed them that the front desk had a list of non-ambulatory residents and that the fire department would assist them with evacuation. When they enquired with the front desk about the availability of the list of non-ambulatory residents they were told that there was no list. Per Resident #1, the front desk staff may have been new or confused. Per interview with Jessica Saks, the front desk does have a list. It is kept in a folder at the front desk. A copy of the list was provided on today's visit. Per tour of 2 of the 7 stairwells conducted at 2:14pm on today's visit, evacuation chairs were observed at the top of the stairwells. Based on the information obtained during the investigation, there is insufficient evidence to support the allegation that staff did not evacuate resident during a fire, therefore the allegation is unsubstantiated.

Per the investigation into Allegation #2 - Staff not properly trained for fire evacuation, the investigation revealed that the facility has 8 floors and is considered a high rise. The building was constructed with fire rated walls and doors that are fire rated for 90 minutes. The Fire Marshal shows up unannounced monthly to conduct fire drills for all three shifts and evacuation drills are conducted annually. Per review
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20230809144351
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: VARIEL OF WOODLAND HILLS, THE
FACILITY NUMBER: 195850240
VISIT DATE: 12/12/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
of the fire drill logs for 2023 and 2024, employees from every shift receive training alternately every 3 months. A different case scenario is simulated and the staff are trained on the responses and notifications to the appropriate agencies. Staff are also trained on the use of fire extinguishers. Based on the review of facility training records, there is insufficient evidence to support the allegation that the staff are not properly trained for fire evacuations, therefore the allegation is unsubstantiated at this time.



Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3