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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850240
Report Date: 10/30/2025
Date Signed: 10/30/2025 02:45:19 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
08/25/2025 and conducted by Evaluator Angela Barutyan
COMPLAINT CONTROL NUMBER: 29-AS-20250825121624
FACILITY NAME:VARIEL OF WOODLAND HILLS, THEFACILITY NUMBER:
195850240
ADMINISTRATOR:LOURDES BUSTAMANTEFACILITY TYPE:
740
ADDRESS:6233 VARIEL AVETELEPHONE:
(818) 651-6018
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:436CENSUS: 370DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jessica SaksTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Due to lack of supervision, resident injured another resident while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation for the allegation listed above at 11:28AM. LPA met with staff and Director of Nursing (DN) Jessica Saks upon arrival and Executive Director (ED) Allison Marty who arrived shortly thereafter. Entrance interview conducted.

During today’s visit, LPA interviewed two (2) staff and reviewed and obtained copies of pertinent documents. During the initial visit on 08/27/2025, LPA conducted interviews with four (4) staff and three (3) residents, reviewed and obtained copies of pertinent documents relevant to the investigation, conducted a brief physical plant tour, and discussed the allegation with Administrator Lourdes Bustamante.

Report Continued on LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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-20250825121624
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: 10/30/2025
NARRATIVE
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It was alleged that due to lack of supervision, Resident #1 (R1) threw an object, possibly a telephone, at Resident #2 (R2) causing R2 to sustain a C1 fracture. Staff and resident interviews revealed that R1 did throw an object at R2 resulting in injury. The Woodland Hills North Regional Office received an incident report and SOC 341 from the facility on 08/22/2025 stating that on 08/21/2025, R1 threw a hard object at the back of R2’s head in the dining room and R2 reported pain in the area. R2 was assessed and admitted to the hospital. Record review and interview revealed that R2 had a previous C1 fracture and it is unknown if the incident caused a new fracture or aggravated the pre-existing fracture. LPA interviewed R1, R2, and R1’s responsible party and no evidence of malicious intent was noted. R1 and R2 stated there is no lack of care and supervision being provided. Following the incident on 08/21/2025, R1 was seen by their physician and received new medication orders. Interviews with staff and R1’s responsible party noted that the medication change has been effective in addressing R1’s behavior. Interviews stated that R1 did not have a history of aggressive behaviors, and no similar incidents have occurred as of today’s visit. Interviews confirmed that two (2) kitchen staff members were nearby during the incident and R2 received medical attention immediately upon notifying staff. LPA reviewed records and observed that R1’s assessment signed and dated on 03/23/2025 document that R1 does not need supervision to perform activities of daily living (ADL), behavior management, or escorting and that R1 is oriented. R1’s physician’s report signed and dated on 07/07/2025 document that R1 exhibits confusion and is disoriented inconsistently and does not have aggressive or inappropriate behaviors. R2’s assessment signed and dated on 02/06/2025 documents that R2 needs some ADL and transfer assistance but does not need escorting and is oriented. R1 and R2’s care plans do not include 24/7 supervision or supervision in common areas. As R1 and R2 do not require supervision in common areas and the facility made a quick and effective response in addressing R1’s behavior, there is not sufficient evidence to support a lack of supervision. Based on interviews and record review, the information obtained during the investigation does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the above allegation “Due to lack of supervision, resident injured another resident while in care” is deemed UNSUBSTANTIATED at this time.


No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
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