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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850111
Report Date: 07/17/2025
Date Signed: 07/17/2025 04:10:45 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
05/09/2025 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20250509105450
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: 68DATE:
07/17/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Joanna Enriquez, Interim EDTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not provide adequate supervision resulting in resident leaving the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit regarding the above noted allegation. LPA met with Interim Executive Director (ED) Joanna Enriques and Clinical Director Davi Rivas, RN, and explained the reason for the visit.

On 5/15/2025, LPA reviewed documents and video, interviewed the clinical director, and interviewed Resident 1 (R1). On 7/10/2025, LPA reviewed documents and was informed R1 moved out of the facility as they preferred living with relatives. During LPA's interview with R1 on 5/15/2025, R1 was oriented to time, place, and person. R1 recalled the incident which occurred on the day they moved into the facility. R1 stated they were looking for their daughter after furniture had been delivered. R1 did not realize their daughter had left to use the

(continued to LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
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-20250509105450
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: 07/17/2025
NARRATIVE
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(continued from LIC9099)

restroom and thought their daughter had gone downstairs to greet other family who were coming to visit that evening. R1 was only confused about where their daughter went, not where they were. R1 went to the facility to recover from a medical condition. R1 needed to use a wheelchair due to being weak from recovery but could maneuver the wheelchair on their own. R1's physician's report stated they needed physical transfer assistance. R1 does not have a cognitive disability. Based on documents, interviews and observation, this allegation is deemed UNSUBSTANTIATED at this time.

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

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2