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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609882
Report Date: 07/17/2025
Date Signed: 07/17/2025 03:17:16 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.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
04/04/2025 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20250404124716
FACILITY NAME:4TH GENERATION SENIOR LIVING INC.FACILITY NUMBER:
197609882
ADMINISTRATOR:MANAHAN, JASMINFACILITY TYPE:
740
ADDRESS:23259 VICTORY BLVDTELEPHONE:
(747) 226-0923
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 6DATE:
07/17/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jasmin ManahanTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff are doing wound care for resident
Staff are doing finger pricks for resident
Staff are not properly preparing food
INVESTIGATION FINDINGS:
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At approximately 9:30 a.m. on 07/17/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 04/09/25 and interviewed Staff #1 (S1) at 10:15 a.m., Resident #2 (R2) at 10:30 a.m., Resident #3 (R3) at 10:40 a.m., and the licensee at 3:00 p.m., conducted a record review of pertinent records, including but not limited to a medical assessment, care plan, home health and hospice files, and a client roster at 11:00 a.m., and toured the facility inside and out at 10:45 a.m. Today, LPA toured the facility at 9:45 a.m., interviewed the administrator at 10:00 a.m., Staff #2 (S2) at 2:30 p.m., and two (02) other residents between 2:40 p.m. and 3:15 p.m.

Regarding the allegation "Staff are doing wound care for resident" it was alleged staff were performing wound care for Resident #1 (R1) without proper training. Record review of R1’s hospital discharge record from 02/24/25 indicated they had a healing, unstageable pressure injury on their sacrum.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
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 31-AS-20250404124716
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: 4TH GENERATION SENIOR LIVING INC.
FACILITY NUMBER: 197609882
VISIT DATE: 07/17/2025
NARRATIVE
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 Review of R1’s hospice plan of care revealed R1 obtained hospice services on 03/12/25. R1 was unavailable for interviews during the course of investigation. Interview with the licensee revealed all staff were trained on daily skin care for R1 and only assisted with skin care which was ordered by the physician. Interview with the administrator confirmed that all staff received training on R1’s skin care which consisted of patting dry and applying a skin ointment. Record review of R1s hospice documents revealed their physician prescribed orders for Calmoseptine skin ointment and staff were instructed to ”apply a thin layer of Calmoseptine topical… daily and as needed…for skin care”. Interviews with S1 and S2 confirmed they followed physician orders for R1’s skin care and they attended the training provided by the hospice nurse. Based on interviews and record review, although the allegation is valid, there is not enough evidence to verify it is true. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
Regarding the allegation "Staff are doing finger pricks for resident" it was alleged staff checked the blood sugar level of R2 by pricking their finger. Interview with R2 did not reveal any pertinent information to the investigation. Interview with the licensee confirmed R2 used to do their own blood sugar level checks without staff assistance. Interview with the administrator confirmed R2 used to perform their blood sugar lever checks independently. R2 later acquired home health services to perform checks about once a week. Record review of R2’s home health orders revealed staff were to “assess compliance to regular finger stick blood sugar checks”, and the home health nurse was to assist with blood sugar checks. Record review of R2’s home health visit logs revealed that a home health nurse visited R2 about once a week since 08/01/24 to check R2’s vitals and blood sugar levels. Interview with S1 and S2 revealed they have never performed finger pricks on R2. No residents interviewed ever witnessed staff perform blood sugar checks on R2. Based on interviews and record review, R2 receives assistance form their home health care provider for blood sugar checks, and staff have not performed finger pricks. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
Regarding the allegation "Staff are not properly preparing food" it was alleged food was cooked and left out all day to spoil. During facility tours on 04/09/25 and today, LPA observed adequate supplies of perishable and non-perishable foods which were properly stored. All food was in good condition. Interview with the licensee and administrator noted food is always prepared and stored properly. Spoiled food is thrown out. Interviews with four (04) out of four (04) residents interviewed revealed the food is good quality and to their likings. Based on observations and interviews, the facility prepares food properly. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

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

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2