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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608381
Report Date: 09/20/2024
Date Signed: 09/20/2024 12:17:14 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.ASC, 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
07/18/2024 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20240718083724
FACILITY NAME:BE WELL SENIOR LIVING II INC.FACILITY NUMBER:
197608381
ADMINISTRATOR:MELNIKOV, RUSLANFACILITY TYPE:
740
ADDRESS:5711 BECKFORD AVENUETELEPHONE:
(818) 578-5839
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:6CENSUS: 6DATE:
09/20/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Irene BadaguasTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Facility staff are not providing records to responsible person
INVESTIGATION FINDINGS:
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At 11:00 a.m. on 09/20/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with staff and disclosed the reason for the visit.

To investigate the allegation above, LPA conducted an initial visit on 07/18/24 and toured the facility at 10:30 a.m., interviewed staff, residents, and family between 11:00 a.m. and 4:30 p.m., and conducted a records review at 1:00 p.m. of documents pertinent to the investigation, including but not limited to hospice records, medical assessments, admission agreements, identification forms, and service plans.

Regarding the allegation “Facility staff are not providing records to responsible person” it was alleged the facility did not provide the hospice records of Resident #1 (R1) to their responsible person when requested. Interview with Family Member #1 (F1) at 2:30 p.m. on 07/18/24 revealed that they believed they were R1’s responsible person. F1 requested their hospice records from the facility prior to R1 moving out and the licensee did not provide them.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
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 31-AS-20240718083724
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BE WELL SENIOR LIVING II INC.
FACILITY NUMBER: 197608381
VISIT DATE: 09/20/2024
NARRATIVE
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Record review of R1’s Identification and Emergency Contact form and R1’s admission agreement revealed R1’s responsible person to be Family Member #2 (F2). Interview with F2 at 4:15 p.m. on 07/18/24 revealed they had never requested R1’s records. Interview with the licensee at approximately 12:00 p.m. on 07/18/24 revealed F2 signed R1’s facility admission documents upon admission and was designated as R1’s responsible person. The licensee confirmed F1 requested R1’s hospice records. Since F1’s request was not specific, the licensee referred F1 to R1’s hospice agency for the records. Based on interviews and record review, the facility was able and willing to provide R1’s records to their responsible person, and they maintained R1’s records’ confidentiality. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety risks were observed during today’s inspection.
Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2