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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610149
Report Date: 01/11/2023
Date Signed: 01/11/2023 12:37:43 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-20221109123313
FACILITY NAME:HOME CARE OF WEST HILLS #1 LLCFACILITY NUMBER:
197610149
ADMINISTRATOR:HILADO, STEPHANIE L.FACILITY TYPE:
740
ADDRESS:22454 SCHOOLCRAFT STREETTELEPHONE:
(818) 610-7276
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 5DATE:
01/11/2023
UNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Stephanie Hilado - AdministratorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Uncleared adults at the facility

Facility staff restrained (tied) residents while in care

Facility staff does not provide a safe environment for residents while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations, LPA initially met with staff Vivian Medina who called the administrator. The administrator arrived within thirty (30) minutes and LPA explained the reason for the visit.

LPA conducted physical plant tour at 9:15 AM, requested copies of facility documents relevant to the investigation at 9:45 AM and interviewed staff and residents between 10:00 AM to 12:00 PM.

Regarding the allegation that the facility an uncleared adults are present at the facility, it was alleged that the former owner of this facility still comes in at the facility. LPA's record review during today's visit at 9:45 AM and prior visit on 11/10/22 at 9:43 AM including but not limited to Licensing Information System (LIS), Guardian Background System (Guardian) and Court order (case no.: 6119098301F and OAH No. 201909413) revealed that the former owner of the facility is finger print cleared and allowed to visit the facility at anytime. (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-20221109123313
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 #1 LLC
FACILITY NUMBER: 197610149
VISIT DATE: 01/11/2023
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
(continued from LIC 9099)

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 10:00 AM to 12:00 PM and prior visit on 11/10/22 at 10:00 AM 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 five (5) staff today between 10:00 AM and 12:00 PM and prior visit on 11/10/22 between 9:50 AM to 11:30 AM revealed that five (5) out of five (5) staff, three (3) of them live in caregiver, did not witness any resident being restrained or tied up.

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 10:00 AM to 12:00 PM and prior visit on 11/10/22 at 10:00 AM 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 nice, respectful and take care of them. LPA's interview with five (5) staff today between 10:00 AM and 12:00 PM and prior visit on 11/10/22 between 9:50 AM to 11:30 AM revealed that five (5) out of five (5) staff, three (3) of them live in caregiver, did not 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