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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850377
Report Date: 05/23/2025
Date Signed: 05/23/2025 02:21:01 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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/19/2025 and conducted by Evaluator Kelly Dulek
COMPLAINT CONTROL NUMBER: 29-AS-20250519141950
FACILITY NAME:HOMELIFE SENIOR LIVING 6FACILITY NUMBER:
565850377
ADMINISTRATOR:LEVENTER, DVORAFACILITY TYPE:
740
ADDRESS:360 ARCTURUS STTELEPHONE:
(805) 338-4448
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 6DATE:
05/23/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Dvora (Debbie) LeventerTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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Staff handled resident in a rough manner
Staff does not have proper training
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kelly Dulek and Investigations Branch (IB) Investigator Jorge Rojas conducted an initial complaint investigation for the allegations listed above. LPA and Investigator arrived at the facility at 09:40AM and met with Administrator Dvora (Debbie) Leventer. Entrance interview conducted.

During today's visit, LPA and Investigator interviewed Administrator at 09:47AM, observed staff transferring a resident at 10:43AM, spoke with Resident #1 (R1)'s family member over the telephone at 11:13AM, toured the facility at 11:42AM, conducted staff and resident interviews from 12:00PM to 01:20PM, and reviewed and obtained copies of relevant documents. The following was then determined:

It was alleged that staff handled R1 roughly, resulting in injury and staff are not trained properly. Record review revealed that R1 moved into the facility on 01/10/2025 and had a medical history

Report Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
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-20250519141950
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: HOMELIFE SENIOR LIVING 6
FACILITY NUMBER: 565850377
VISIT DATE: 05/23/2025
NARRATIVE
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including multiple lumbar fractures and osteoporosis. Interviews revealed that R1 suffers from chronic pain, particularly in their back. On 05/11/2025, R1 was being transferred by 2 (two) facility staff when R1 reported pain in their arm/upper back. R1 reported Staff #1 (S1) had caused the pain. Interview revealed that staff always use a 2-person transfer when working with R1 and that at the time of the alleged injury, 2 (two) staff were present. Interview also revealed that R1 had made similar allegations whenever a new staff began working with R1, which has occurred at least 4 (four) times since R1 has lived at the facility. LPA and investigator observed staff transferring a resident during today's visit and at no time did the staff hold or pull on the resident's arms, as is alleged in the complaint. R1's family member stated that they have personally witnessed S1 transfer and provide care to R1 and has no concerns with S1 or any of the staff at the facility. LPA reviewed training records for 3 (three) staff. All training records were complete and all training is in compliance with Title 22 Regulations. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation, therefore the allegation is deemed Unsubstantiated at this time.

No citations issued. Exit interview conducted. A copy of today's report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
LIC9099 (FAS) - (06/04)
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