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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609317
Report Date: 11/28/2023
Date Signed: 11/28/2023 07:40:31 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
11/20/2023 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20231120144802
FACILITY NAME:BLUE HORIZONFACILITY NUMBER:
197609317
ADMINISTRATOR:DAVTIAN, ZHANNAFACILITY TYPE:
740
ADDRESS:11727 BLYTHE STREETTELEPHONE:
(818) 640-4703
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 5DATE:
11/28/2023
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Zhanna DavtianTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Staff are illegally evicting residents.
Residents are not treated with dignity or respect by staff or other persons.
Facility door is locked with a key prohibiting residents from entering or exiting the facility without staff assistance.
INVESTIGATION FINDINGS:
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On 11/28/2023, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial visit to investigate the allegations listed above. The LPA met with the Administrator Zhanna Davtian and explained the reason for the visit.

At 12:30 p.m. the LPA and the administrator conducted a brief tour of the facility to inspect doors and locks. The LPA requested and reviewed records pertaining to the investigation at 1:00 p.m. The LPA interviewed the Administrator at 1:30 p.m. and residents from 2:00 p.m. to 2:45 p.m. The LPA interviewed the Reporting Party (RP) on 11/28/2023 at 11:30 a.m. The RP stated that they called the Centralized Complaint and Information Bureau (CCIB) an hour after the they had filed the complaint and they wanted to retract it, due to everything being okay now. However, the CCIB analyst told the RP that the department cannot retract the complaint, and it would still be investigated.
Continues on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
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-20231120144802
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: BLUE HORIZON
FACILITY NUMBER: 197609317
VISIT DATE: 11/28/2023
NARRATIVE
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Page 2.

Staff are illegally evicting residents.

On the allegation that staff are illegally evicting residents, it is the concern of the Reporting Party (RP) that the Administrator is illegally evicting residents by not giving enough days to vacate the facility. To investigate the allegation, the LPA conducted interviews. The interview with the RP revealed that a resident had received an eviction notice, but the eviction notice was withdrawn the same day, after the resident and the administrator had a discussion pertaining to the events that led to the eviction notice. The interview with the Administrator revealed that there was an incident, which violated the House Rules; consequently, the administrator gave an eviction notice, which was quickly retrieved after the incident was resolved. The LPA interviewed four (4) out five (5) residents about eviction notices. The residents’ interviews revealed that they had not received eviction notices since they were admitted to the facility.

Based on the information obtained through interviews, and record review, the allegation of unlawful eviction is found to be Unsubstantiated at this time.

Residents are not treated with dignity or respect by staff or other persons.

On the allegation that residents are not being treated with respect; it is the RP’s concern that residents are not allowed to and are restricted within the privacy of their own bedrooms to act freely. To investigate the allegation, the LPA conducted interviews. The interview with the RP revealed that the relative of one of the residents was disrespectful to another resident, and not staff to residents. The interview with the Administrator revealed that typically the residents have family visitation either in the common area (living room/dining room) or outside in the patio area. The LPA interviewed four (4) out five (5) residents about their treatment by staff. The residents’ interviews revealed that they do not feel disrespect by staff, and they are treated well. They have not felt disrespect by other people either.

Based on the information obtained through interviews, the allegation of staff violating the residents’ rights, is found to be Unsubstantiated at this time.

Continues on LIC 9099 C... page 3.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20231120144802
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: BLUE HORIZON
FACILITY NUMBER: 197609317
VISIT DATE: 11/28/2023
NARRATIVE
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Page 3.

Facility door is locked with a key prohibiting residents from entering or exiting the facility without staff assistance.

On the allegation that the facility’s door is locked with a key prohibiting residents from entering or exiting the facility without staff assistance; it is the RP’s concern that residents are being restricted to leave the facility freely at their own will and are locked out because residents don’t have a front door key and must wait for staff to open the door for them. To investigate the allegation, the LPA conducted interviews. The interview with the RP revealed that the allegation was about the front gate and not the front door of the facility. The RP stated that the front door does not have a lock, and the fence gate is kept locked from the outside. The residents have to wait for staff to open the gate from the inside, when they return from personal outings. The interview with the Administrator revealed that gate is kept locked from the outside due to activity in the neighborhood, and safety reasons for all residents and staff. The interview with four (4) out of five (5) of residents revealed that they are not prohibited from leaving or entering the facility without staff assistance. They can come and go as they please.

Based on the information obtained through interviews, the allegation of staff prohibiting residents from entering or exiting the facility without staff assistance, is found to be Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted. A copy of the report was issued via email.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3