Complaint Investigation Report

197608267-1-22-2025-31-AS-TAGD-DDJTRL-20250203135740

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

01/06/2025 and conducted by Evaluator Gina Saucedo

COMPLAINT CONTROL NUMBER: 31-AS-20250106131753

Staff did not properly report incidents involving residents

On 01/22/25, at 9:25am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Resident Care Director Mary Jane Reyes. LPA explained the purpose of this visit was to deliver findings for this complaint. On 01/09/25, LPA Segovia conducted an initial complaint and asked for the census, staff, and resident rosters.

Regarding the allegation: Staff did not properly report incidents involving residents. It is being alleged a Community Care Licensing (CCLD) employee confirmed no SOC 341 was received by the facility for this alleged abuse. On 01/30/24, LPA Saucedo investigated complaint # 31-AS-20240123163901 regarding an incident related to the SOC 341 that was allegedly not reported to licensing. In the complaint received on 01/23/24, was attached the SOC 341. In addition, there was an Unusual Incident/Injury Report sent to Community Care Licensing Department on 01/23/2024 by facility confirming the incident that took place. During an interview with the CCLD employee, they did not recall providing confirmation that an SOC 341 was or was not received. Therefore, based on the LPA's record review and staff interview the above allegation(s) above is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given.