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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603296
Report Date: 07/21/2025
Date Signed: 07/22/2025 03:13:38 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2025 and conducted by Evaluator Perchui Khurshudyan
COMPLAINT CONTROL NUMBER: 31-AS-20250714092054
FACILITY NAME:FAIRWINDS - WEST HILLSFACILITY NUMBER:
197603296
ADMINISTRATOR:ELVIS GUTIERREZFACILITY TYPE:
740
ADDRESS:8138 WOODLAKE AVETELEPHONE:
(818) 713-0900
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY:130CENSUS: 96DATE:
07/21/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gutierrez Elvis - General ManagerTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff did not prevent resident from engaging in verbal altercations with other residents.
Staff are not providing a comfortable environment for residents.
INVESTIGATION FINDINGS:
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On 7/21/2025, Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Leslie Ngo-Castaneda conducted an unannounced 10-day complaint visit to the facility to investigate the above allegation. Upon arrival, LPAs introduced themselves by showing their department badges, met with the Facility General Manager Gutierrez Elvis and explained the reason for the visit. Entrance interview conducted.

At 9:20am, LPAs requested copies of resident and staff rosters. LPA also requested copies of Physician’s Report, Admission Agreement, Appraisal Needs and Services Plan, Medication list, copy of Incident Reports, copy of facility internal investigation report, and potential documents relevant to the investigation. At approximately 9:45am, LPAs conducted a physical plant tour to ensure the health and safety of the residents are protected. No immediate health and safety hazards were noted during the visit. Between 10:00am – 12:40pm, LPA conducted interviews with the facility General Manager, four (4) staff/caregivers, and nine (9) out of ninety-six (96) residents residing at the facility.
Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
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 3
Control Number 31-AS-20250714092054
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: FAIRWINDS - WEST HILLS
FACILITY NUMBER: 197603296
VISIT DATE: 07/21/2025
NARRATIVE
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Allegation: Staff did not prevent resident from engaging in verbal altercations with other residents.

It was reported by Resident #1 - R1 that there was an incident back on January 3rd 2025, where R1 got involved in verbal altercation with R2. To investigate the allegation, during today’s visit, LPAs interviewed the General Manager, four (4) staff/caregivers, and nine (9) out of ninety-six (96) residents residing at the facility. LPAs also reviewed R1 and R2 files, incident reports, and facility internal investigation reports. Interviews with staff members confirmed that a verbal interaction occurred between two residents (R1 and R2) on February 3rd 2025, and they described the situation as a brief verbal disagreement near the elevator area. Staff were immediately alerted to the situation and responded promptly. They separated the residents, de-escalated the interaction, and ensured that both parties were safe and calm. The management followed the internal procedures by documenting the incident, notifying appropriate parties, and facility driver transported R1 to UCLA West Valley Medical Center - ER for evaluation, as R1 mentioned that during the verbal altercation R2 swung the empty canvas bag, did not hit R1, however, R1 wrenched the right side of the body and was in pain. Staff continually monitored both residents R1 and R2 for any signs of distress or further conflict. Interviews with residents confirmed that the staff presence and intervention are always timely and appropriate. No evidence of negligence or lack of supervision observed during today’s visit on the part of the facility staff. Residents also denied of witnessing or observing any ongoing issues between residents residing in the community and stated that they feel safe and supervised at all times. Although, the verbal altercation did occur between R1 and R2, staff responded immediately and intervened appropriately to manage the situation. Therefore, based on interviews, records review and observation, the allegation that staff did not prevent a resident from engaging in verbal altercation with other resident is Unsubstantiated at this time.

Continue on LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250714092054
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: FAIRWINDS - WEST HILLS
FACILITY NUMBER: 197603296
VISIT DATE: 07/21/2025
NARRATIVE
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Allegation: Staff are not providing a comfortable environment for residents.

It was reported by R1 that there was an incident back on January 3rd, where R1 got involved in verbal altercation with R2. R1 also reported that about four to six (4-6) weeks ago R1 had scabies and that R1 was told by the facility’s attorney that R1 brought the scabies in through his/her parakeet. To investigate the complaint, LPAs interviewed the General Manager, four (4) staff/caregivers, and nine (9) out of ninety-six (96) residents residing at the facility. LPAs also reviewed R1 and R2 files, incident reports, and facility internal investigation reports. In course of the investigation, interviews and review of medical records confirmed that Resident #1 (R1) had reported skin condition in March 2024, described a rash on their body. R1 was assessed by dermatologist, who confirmed that the rash was diagnosed as scabies. Upon receiving the diagnosis, the facility staff took immediate and appropriate action in line with infection control protocols. R1 and R1’s spouse who also resides in the same room were temporarily isolated to prevent the possible spread. Both residents received prescribed medication treatment as ordered by the physician. There were no additional reports of skin rash or scabies symptoms among other residents or staff members before or after the incident. Staff members also confirmed that enhanced cleaning and sanitizing procedures were conducted. Interviews with multiple residents indicated they feel safe and comfortable in the facility. Residents reported satisfaction with the living conditions and the attentiveness of the staff. All residents interviewed denied of ever having skin rash or scabies while residing in the facility. Observations made during the facility visit showed a clean, well maintained, and welcoming environment. No evidence was found to support the claim that the environment is not conducive to resident comfort.

Based on the information obtained through interviews, documentation review, and on-site observations, there is insufficient evidence to support the allegation of staff failing to provide safe environment for residents. Therefore, the allegation listed above is deemed Unsubstantiated at this time.

No deficiency cited during today’s visit.

Exit interview conducted, copy of the report delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3