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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610147
Report Date: 01/11/2023
Date Signed: 01/11/2023 03:48:44 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
11/09/2022 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20221109131413
FACILITY NAME:HOME CARE OF WEST HILLS #2 LLCFACILITY NUMBER:
197610147
ADMINISTRATOR:CAPATAYAN, GLENN R.FACILITY TYPE:
740
ADDRESS:22523 SCHOOLCRAFT STREETTELEPHONE:
(818) 932-0079
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 5DATE:
01/11/2023
UNANNOUNCEDTIME BEGAN:
12:34 PM
MET WITH:Joanne Gatela - StaffTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff restrained (tied) residents while in care.

Facility staff does not provide a safe environment for residents while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations, LPA met with Staff Joanne Gatela and explained the reason for the visit.

LPA conducted physical plant tour at 12:35 PM, requested copies of facility documents relevant to the investigation at 1:00 PM and interviewed staff and residents between 1:10 AM to 2:30 PM.

Regarding the allegation that Facility staff restrained (tied) residents while in care, it was alleged that residents were being tied without any doctor's approval. LPA's interview today between 1:10 PM to 2:30 PM and prior visit on 11/10/22 between 1:15 to 3:00 PM revealed that four (4) out of four (4) residents interviewed did not witness any resident being restrained or tied by the staff. LPA's interview with four (4) staff today between 1:10 PM and 2:30 PM and prior visit on 11/10/22 between 1:15 PM to 3:00 PM revealed that four (4) out of four (4) staff, two (2) of them live in caregiver, did not witness any resident being restrained or tied up. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023
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-20221109131413
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: HOME CARE OF WEST HILLS #2 LLC
FACILITY NUMBER: 197610147
VISIT DATE: 01/11/2023
NARRATIVE
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(continued from LIC 9099)

Regarding the allegation that facility staff does not provide a safe environment for residents while in care, it was alleged that residents were being maltreated and abused by the staff, LPA's interview today between 1:10 PM to 2:30 PM and prior visit on 11/10/22 between 1:15 to 3:00 PM revealed that four (4) out of four (4) residents interviewed did not witness or heard any of the residents being physically or verbally abused by any staff and stated that staff are generally respectful and take care of their needs. LPA's interview with four (4) staff today between 1:10 PM and 2:30 PM and prior visit on 11/10/22 between 1:15 PM to 3:00 PM revealed that four (4) out of four (4) staff, two (2) of them live in caregiver, denied physically and/or verbally abusing nor maltreated or disrespected any resident nor did they witness any staff being verbally or physically abusive to any resident nor they witness anyone being disrespectful to any resident.

Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2