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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850370
Report Date: 07/25/2025
Date Signed: 08/20/2025 03:18:55 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
07/24/2025 and conducted by Evaluator Erica Mosley
COMPLAINT CONTROL NUMBER: 29-AS-20250724143004
FACILITY NAME:COLONY OF THOUSAND OAKS AT SIDLEE WEST INCFACILITY NUMBER:
565850370
ADMINISTRATOR:ROUSH, CONNIEFACILITY TYPE:
740
ADDRESS:171 WEST SIDLEE STREETTELEPHONE:
(805) 496-4541
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 5DATE:
07/25/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Licensee Representative- Dr. Rashita Aggarwal
Administrator - Eleanor Jimenez
TIME COMPLETED:
04:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff admitted a resident with a prohibited health condition
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Erica Mosley conducted an initial 10-day complaint visit to investigate the above allegation. Upon arrival approx at 10:45 a.m., LPA Mosley was greeted by Staff who called the Administrator to inform them of the visit. The Administrator Eleanor Jimenez and Licensee Representative/ Administrator Dr. Rashita Aggarwal arrived shortly after and the reason for the visit was explained. Entrance interview conducted.

On 07/24/2025, the Department received a complaint regarding the following allegation, Staff admitted a resident with a prohibited health condition. LPA and staff toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards and facility is in compliance with Title 22 Regulations.

Report continued on LIC 9099-C PAGE 2...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025
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-20250724143004
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: COLONY OF THOUSAND OAKS AT SIDLEE WEST INC
FACILITY NUMBER: 565850370
VISIT DATE: 07/25/2025
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
(PAGE 2) Report continued from LIC 9099...

During today’s visit, starting at 10:51 a.m. LPA and staff conducted a physical plant tour to ensure there are no immediate health and safety concerns and facility is in compliance with Title 22 Regulations, starting at 11 a.m. conducted eight (8) in-person interviews, with three (3) residents including Resident #1 (R1), two (2) family visitors, four (4) staff including the Licensee Representative, and Administrator, attempted four (4) telephonic interviews, at 12:39 p.m. conducted a file review for R1 and obtained copies of pertinent documents relevant to the investigation.

On the allegation Staff admitted a resident with a prohibited health condition, it is the concern of the Reporting Party (RP) that the facility staff admitted R1 with a prohibited health condition of a gastrostomy tube (g-tube) and are unaware if the facility can accept or treat R1 with the g-tube. To investigate this complaint, LPA conducted four (4) in person interviews with the staff including the Licensee Representative, and Administrator, and conducted a file review on R1. Interview with the Licensee representative and Administrator revealed that R1 has been on Hospice since 01/17/2025 and submitted all the required documentation to licensing. R1 is seen 2-3 times a week by the hospice agency who handle and care for R1 g-tube. Licensee Representative also noted that they are licensed physician, an appropriately skilled professional who is available on site to monitor R1’s feeding and assess the insertion site on a daily basis, as they are regularly at the facility to monitor R1. Staff interviews revealed that the hospice agency is regularly at the facility ranging from 2-3 times a week monitoring R1’s g-tube. Staff also noted that the Licensee representative, Dr. Rashita Aggarwal is at the facility on a daily basis and monitors R1 focusing on the g-tube. File review revealed that R1 is receiving hospice services and have been on hospice since 01/17/2025. The agency is scheduled to have a minimum of 3 visits a week and handle R1’s plan of care including the g-tube. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Staff admitted a resident with a prohibited health condition is deemed unsubstantiated at this time.

Exit interview conducted. A copy of the report provided.

*This report has been amended to remove confidential information*

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3