Complaint Investigation Report

197610582-5-22-2026-31-AS-MGFS-DUBQMY-20260522121819

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

WOODLAND HILLS S.RO , 21731 VENTURA BLVD., STE. 250

This is an official report of an unannounced visit/investigation of a complaint received in our office on

01/19/2026 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20260119231501

Staff did not provide adequate care and supervision to the residents

This report supersedes report dated 3/3/26 and that the report was amended to remove confidential information.

Regarding the Allegation: Staff did not provide adequate care and supervision to the residents. It is alleged staff left R1 on the bathroom floor alone after a fall. Interviews revealed that R1 had a fall on the night of 01/16/26. S1 did not obtain medical services for R1. Instead, S1 stayed with R1 until the following morning, when the family arrived at approximately 10:40am, to call the paramedics. R1 was taken to the hospital, requiring surgery for a broken hip and dislocated shoulder. S1 stated to not have call 911 as they were scared to get in trouble. S1 did what they could’ve done best, by staying alongside R1 until family can call 911. Based on information obtained during that visit, the above allegation was Substantiated. Additional information was received during an interview with Resident #1(R1)’s responsible party on 03/03/26 after the visit which revealed S1 had stayed with R1, did not leave R1 alone, and was present to provide supervision.Based on this review, although proper care was not provided to R1, there was evidence that S1 stayed with R1, after they experienced a fall, to provide some sort of supervision. Therefore, the allegation of staff not providing adequate care and supervision to the resident is deemed Unsubstantiated at this time.

A copy of this report LIC 9099 was mailed to the licensee’s last known mailing address.