565802431-5-7-2025-29-AS-KHEN-DH4QFL-20250528120807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802431
Report Date: 05/07/2025
Date Signed: 05/07/2025 03:09:40 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/06/2024 and conducted by Evaluator Angela Barutyan

COMPLAINT CONTROL NUMBER: 29-AS-20241206165420

FACILITY NAME:	SELECT SENIOR LIVING II		FACILITY NUMBER:	565802431
ADMINISTRATOR:	KATHLEEN LEITERMAN		FACILITY TYPE:	740
ADDRESS:	113 ERTEN STREET		TELEPHONE:	(805) 852-8789
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 4	DATE:	05/07/2025
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Kim Anderson		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Facility did not involve the prospective resident or his/her responsible person, in the development of the appraisal

Facility did not properly disclose preadmission fee

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation at 10:55AM. Upon arrival, LPA met with staff and Administrator Kim Anderson who arrived at 11:10AM. Entrance interview conducted.

During today’s visit, LPA Barutyan conducted a brief physical plant tour at 10:57AM, interviewed five (5) staff between 11:02AM-12:40PM, and reviewed and obtained copies of pertinent documents. During the initial visit on 12/16/2024, LPA Z. Chochian reviewed resident files and obtained copies of pertinent documents at 03:20PM, discussed allegations with Ms. Anderson, and toured the facility physical plant inside/outside at approximately 4PM.

Report Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

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 3

Control Number 29-AS-20241206165420

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SELECT SENIOR LIVING II	FACILITY NUMBER: 565802431
	VISIT DATE: 05/07/2025

NARRATIVE

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It was alleged that Resident #1 (R1)’s needs and services appraisal was not signed by R1’s responsible parties and that facility staff did not involve R1’s responsible parties in developing the appraisal. LPA reviewed R1’s needs and services appraisal which was completed and signed by Administrator Anderson on 05/28/2024. The appraisal was complete and addressed R1’s socialization, emotional, mental, physical/health, and functioning skills needs and objectives. Per interviews, Administrator reviewed the appraisal with R1’s responsible parties and a formal meeting was scheduled to further review and address concerns specifically regarding dementia care. On 07/12/2024, Administrators Anderson and Dylan Hull, along with two (2) responsible parties for R1 were present, either in-person or telephonically, to discuss the appraisal. One (1) responsible party agreed to the care plan and gave verbal consent over the phone, while the other responsible party present did not sign the care plan. Administrator Hull signed the needs and services appraisal on 07/12/2024. Per interviews, responsible parties agreed to the care that was specified in the appraisal. Administrator was knowledgeable in preplacement and appraisal protocol. LPA also reviewed R1’s pre-placement appraisal signed by all parties (Administrator Anderson and R1’s responsible party) and dated 5/20/2024 and R1’s resident appraisal signed by all parties and dated 05/28/2024 which document the elements of care in R1’s needs and services appraisal. Based on interviews and record review, the information obtained during the investigation does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation “Facility did not involve the prospective resident or his/her responsible person, in the development of the appraisal” is deemed UNSUBSTANTIATED at this time.

It was further alleged that the preadmission fee was not properly disclosed to R1’s responsible parties. LPA reviewed R1’s admission agreement signed by R1’s responsible party and dated 05/21/2024 which documents preadmission fee disclosures on page 4 of 17. Under “PRE-ADMISSION FEE (Section 87507(g)(5)(E)(1)” the admission agreement states, “Select Senior Living requires a non-refundable Pre-Admission Fee (aka Community Fee) equal to the first month total on or before admission. This Fee covers the costs incurred by Select Senior Living to process your application and other materials, including your physician's report, perform a pre-admission appraisal, functional assessments, develop your care plan, and admit you to the Community. The Pre-Admission Fee is not a security deposit or last month payment. It is refundable in whole or in part under the following conditions…”

Report Continued on LIC 9099-C.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20241206165420

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SELECT SENIOR LIVING II	FACILITY NUMBER: 565802431
	VISIT DATE: 05/07/2025

NARRATIVE

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The admission agreement documents a preadmission fee amount that is $3000.00 less than the monthly rate being charged. It was alleged that the preadmission fee was not disclosed until R1 was scheduled to move in and the last step required was signing the admission agreement. LPA interviewed staff who stated that the preadmission fee is discussed up-front during facility tours and is also disclosed on the admission agreement which residents or their responsible parties must sign prior to admission. R1’s admission agreement was signed by their responsible party, and therefore the preadmission fee was agreed upon. Based on interviews and record review, the information obtained during the investigation does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation “Facility did not properly disclose preadmission fee” is deemed UNSUBSTANTIATED at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC9099 (FAS) - (06/04)

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