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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608694
Report Date: 06/04/2025
Date Signed: 06/04/2025 03:17:45 PM

Unfounded


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
06/02/2025 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20250602101948
FACILITY NAME:VILLAGE AT SHERMAN OAKS, THEFACILITY NUMBER:
197608694
ADMINISTRATOR:GRACE HARTNETTFACILITY TYPE:
740
ADDRESS:5450 VESPER AVETELEPHONE:
(818) 994-7900
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91411
CAPACITY:179CENSUS: DATE:
06/04/2025
UNANNOUNCEDTIME BEGAN:
11:47 AM
MET WITH:TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Resident fell sustaining injuries due to lack of supervision
Resident did not receive timely medical treatment
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted an initial complaint visit for the above allegations. LPA arrived to the facility at 11:47 AM. LPA met with Executive Director Grace Hartnett. Entrance interview conducted and the reason for the visit was explained.

On June 2, 2025, the Department received a complaint alleging Resident fell and sustained injuries due to lack of supervision and Resident did not receive timely medical treatment. During today’s visit, the LPA conducted a file review for Resident #1 (R1), collected copies of pertinent documents, and conducted an interview with the Executive Director and one (1) independent resident between 12:00 PM and 01:50 PM.

Continued on LIC 9099C.
Unfounded
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
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-20250602101948
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: VILLAGE AT SHERMAN OAKS, THE
FACILITY NUMBER: 197608694
VISIT DATE: 06/04/2025
NARRATIVE
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The interview with the Executive Director revealed that Resident #1 (R1) resided in the building but is an “Independent Living” resident residing in an independent living apartment which is not part of the facility license, and the resident does not receive services from the Residential Care Facility for the Elderly (RCFE) component of the facility. A review of R1’s Residency and Service Agreement dated 11/29/2016 specified in the contract that the agreement did not entitle the resident to receive services in the RCFE component of The Village at Sherman Oaks and that the contract was not a Continuing Care or RCFE Contract. A review of the facility roster also did not reflect R1 as a resident of the licensed facility. The interview with Independent resident #1 (I1) who was a family member of R1 and who also lives in an independent apartment in the building also confirmed that R1 was an independent resident and was not receiving services from the RCFE component of the facility.

Based on the information obtained, R1 did not reside in the licensed facility and did not receive any elements of care or supervision from the licensee. Therefore, the allegations of Resident fell and sustained injuries due to lack of supervision and Resident did not receive timely medical treatment are deemed UNFOUNDED at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted and a copy of the report was provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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