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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610121
Report Date: 03/09/2023
Date Signed: 03/09/2023 02:03:15 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/21/2022 and conducted by Evaluator Tihesha Smith
COMPLAINT CONTROL NUMBER: 31-AS-20221221094559
FACILITY NAME:WEST HILLS ASSISTED LIVINGFACILITY NUMBER:
197610121
ADMINISTRATOR:MILLAN, JONATHANFACILITY TYPE:
740
ADDRESS:7055 SHOUP AVENUETELEPHONE:
(818) 883-7201
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:90CENSUS: 53DATE:
03/09/2023
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Chris SalvadorTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Resident is not free from intimidation or other actions of a punitive nature by facility staff.
Facility staff are allowing residents to smoke inside the facility.
Facility air conditioning is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tihesha Smith made an unannounced complaint visit to this facility at 9:20 am to deliver findings. LPA Smith met with facility staff and disclosed the purpose of this visit. The administrator was contacted and arrived later.

During initial visit, on 12/22/2022, LPA Smith conducted tour of physical plant at 11:40 am, conducted interviews with administrators and requested documents relevant to the investigation.

LPA Smith made a subsequent visit to this facility on 01/31/23. From 12:40 pm-3:00 pm, LPA interviewed six (6) staff, five (5) residents, conducted a physical plant tour and requested pertinent documents at 12:45 PM. LPA was unable to interview Resident #1 (R1) due to time constraints.

The following two out of three allegations for Complaint Control #: 31-AS-20221221094559:

Facility staff are allowing residents to smoke inside the facility
Facility air conditioning is in disrepair

was delivered on 01/31/23 and both allegations were UNSUBSTANTIATED
(Cont to 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
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-20221221094559
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WEST HILLS ASSISTED LIVING
FACILITY NUMBER: 197610121
VISIT DATE: 03/09/2023
NARRATIVE
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(Cont from 9099)

Resident is not free from intimidation or other actions of a punitive nature by facility staff.

It was alleged that Resident is not free from intimidation or other actions of a punitive nature by facility staff. LPA Smith conducted interviews with administrator and resident from 10:10 am-11:05 am. Interview with administrator revealed that staff are not intimidating or punishing residents. Administrator revealed must take appropriate action when any resident refuses or fails to pay rent, fails to follow admissions agreement, or any other written house rules within the facility. Review of ledger and past due rent notices reveal the rent for R1 has not been paid since 10/01/2021 and the facility sent several notifications of the unpaid rent to R1. LPA interview with R1 reveal that they have an eviction for non-payment of rent for over a year. R1 also revealed is currently packing and will be moving with assistance from relative due to court ruling and with notification of sheriff.

Based on interviews and documents obtained during this and previous licensing visits there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2