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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609856
Report Date: 09/25/2024
Date Signed: 09/25/2024 02:01:16 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
09/24/2024 and conducted by Evaluator Perchui Khurshudyan
COMPLAINT CONTROL NUMBER: 31-AS-20240924123647
FACILITY NAME:WESTFIELD SENIOR LIVINGFACILITY NUMBER:
197609856
ADMINISTRATOR:BALASANYAN, MARIAMFACILITY TYPE:
740
ADDRESS:7633 MASON AVETELEPHONE:
(818) 384-1134
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:6CENSUS: 4DATE:
09/25/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Mariam Balasanyan-AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not providing resident with adequate food and liquids while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/25/2024 at approximately 9:45am Licensing Program Analyst (LPA), Perchui Milena Khurshudyan arrived to Westfield Senior Living in response to the above mentioned allegation. Upon arrival LPA met with the facility Administrator and explained the reason for the visit.

It was alleged that facility staff failed to provide adequate food service. To investigate this allegation, LPA conducted a physical plant walk through at 10:15am and observed the refrigerator to be fully stocked with adequate amount of perishable and non-perishable food. Additionally, LPA observed lunch being prepared for the residents, and it was observed to be nutritious. Lastly, LPA conducted interviews with two (2) out of three (3) residents and one (1) family member who was visiting the resident at the time of the visit. Both residents and one family member stated they were happy with the food services and meals they are provided. Based on LPA's observations and interviews, this allegation is deemed Unsubstantiated, at this time.
Exit interview conducted and copy of this report signed and delivered.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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