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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850111
Report Date: 03/20/2025
Date Signed: 03/20/2025 02:45:48 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
03/11/2025 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20250311133256
FACILITY NAME:LEXINGTON ASSISTED LIVINGFACILITY NUMBER:
565850111
ADMINISTRATOR:JILL MORRIS CHAPMANFACILITY TYPE:
740
ADDRESS:5440 RALSTON STTELEPHONE:
(805) 644-6710
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:125CENSUS: 62DATE:
03/20/2025
UNANNOUNCEDTIME BEGAN:
01:03 PM
MET WITH:Jill Morris ChapmanTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility staff locked resident in bedroom
Facility staff did not ensure resident’s records were complete
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Teresa Camara conducted a complaint investigation visit regarding the above noted allegations. LPA met with administrator Jill Morris Chapman and explained the reason for the visit.

At 1:05 p.m. LPA interviewed administrator. At 1:25 p.m. and 1:40 p.m. LPA interviewed staff. At 1:50 p.m. LPA conducted a room inspection in the former room of resident 1 (R1).

Regarding the allegation facility staff locked resident in bedroom: The door was locked so that other residents could not wander into R1's room. This was for R1's safety and preference as R1 did not like other residents in their room. R1's door could be opened from the inside by just turning the door lever; R1 would not have to unlock the door themselves. Based on this information, this allegaiton is deemed Unsubstantiated at this time.

(continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
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 29-AS-20250311133256
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: LEXINGTON ASSISTED LIVING
FACILITY NUMBER: 565850111
VISIT DATE: 03/20/2025
NARRATIVE
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(continued from LIC9099)

Regarding the allegation facility staff did not ensure resident's records were complete: This allegation was regarding R1 being on hospice but not having a completed POLST document. R1 was not conserved nor did R1 have anyone with Power of Attorney over their medical decisions. R1 did not have a next of kin or other responsible party known to the facility. The administrator had been reaching out for assistance from the Long Term Care Ombudsman and Ventura County Adult Protective Services since October of 2024 to get a public guardian for R1. The administrator worked with the hospice agency to get R1 on hospice. The hospice agency obtained reports from two independent physicians as well as their own physician to approve R1 for hospice services. However, all of the physicians stated they could not ethically complete the POLST/DNR (do not resucitate) for R1. R1 was not able to make decisions for themselves. Therefore, the POLST was incomplete. Based on this information, this allegation is deemed Unsubstantiated at this time.

No deficiencies observed. Exit interview conducted and report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2