<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609801
Report Date: 08/31/2023
Date Signed: 08/31/2023 02:57:28 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
08/25/2023 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20230825095056
FACILITY NAME:LAND OF PEACE 5FACILITY NUMBER:
197609801
ADMINISTRATOR:ROSELIN FINULIARFACILITY TYPE:
740
ADDRESS:22625 KITTRIDGE STREETTELEPHONE:
(818) 883-3356
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 5DATE:
08/31/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sona MuradayanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide adequate food service
Staff did not assist resident with her medical appointments
Staff did not dispense resident’s medication as prescribed
Staff did not provide a comfortable environment for resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 9:30 a.m. on 08/31/2023 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with Administrator Sona Muradayan and disclosed the reason for the visit. LPA interviewed staff and residents today between 9:40 a.m. to 1:00 p.m., obtained relevant documents at 10:20 a.m., observed food service at 10:30 a.m., toured the facility at 10:45 a.m., reviewed medication logs at 11:00 a.m., and reviewed records at 1:30 p.m. No immediate health and safety concerns were observed.

Regarding the allegation “Staff did not provide adequate food service” it was alleged the facility food was poor quality. Interview with the Administrator at 9:40 a.m. today revealed lunch and dinner for the facility is catered every day, and the food is kosher and low in sodium. LPA observed the catered food provided at 10:30 a.m. today. Interview with the caterer at 10:35 a.m. today revealed they adjust the food served to meet resident preferences.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
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 2
Control Number 31-AS-20230825095056
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: LAND OF PEACE 5
FACILITY NUMBER: 197609801
VISIT DATE: 08/31/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 Interviews with staff between 11:10 a.m. and 11:40 a.m. today revealed that alternate food options are provided if a resident does not like the catered food provided. Interviews with residents between 12:00 p.m. and 1:15 p.m. today confirmed that staff accommodate resident preferences and needs for food service, and residents did not have any concerns about facility food quality. Based on interviews and observations, there is insufficient evidence to confirm the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff did not assist resident with medical appointments” it was alleged Resident #1 (R1) missed medical appointments due to facility fault. From record review at 1:30 p.m. today, R1’s admission agreement stated the facility would provide “basic transportation to and from medical and dental appointments”. From interviews at 9:40 a.m. and 1:15 p.m. today, the Administrator and R1 stated R1 had not missed any medical appointments. Staff and other residents interviewed between 11:10 a.m. and 1:00 p.m. today stated no residents had missed medical appointments. Based on interviews and record review, there is insufficient evidence to confirm the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff did not dispense resident’s medication as prescribed” it was alleged R1 experienced a delay in receiving medications. Interviews with staff, R1, and other residents today between 9:40 a.m. and 1:15 p.m. revealed residents had no issues with missing medications. Medication log review today at 11:00 a.m. indicated none of R1’s medications were missed. Based on interviews and record review, there is insufficient evidence to confirm the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff did not provide a comfortable environment for resident” it was alleged R1 did not have enough space to maneuver their wheelchair around their shared bedroom. From LPA’s facility tour at 10:45 a.m. today, LPA observed sufficient space for a wheelchair to move about the room. R1 and other residents interviewed today between 12:00 p.m. and 1:15 p.m. stated they had no issues using wheelchairs throughout the facility. Based on interviews and observations, there is insufficient evidence to confirm the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Appeal rights discussed. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2