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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200634
Report Date: 04/25/2023
Date Signed: 04/25/2023 12:05:59 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/28/2023 and conducted by Evaluator Leslie Ibo
COMPLAINT CONTROL NUMBER: 15-AS-20230228102849
FACILITY NAME:ELWYN CALIFORNIA - TERRA VERDEFACILITY NUMBER:
079200634
ADMINISTRATOR:WHITLEY, REBECCA LFACILITY TYPE:
737
ADDRESS:2934 TERRA VERDE LNTELEPHONE:
(925) 418-4168
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:4CENSUS: 4DATE:
04/25/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rebecca Whitley, Administrator TIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff do not treat resident with dignity
INVESTIGATION FINDINGS:
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On 4/25/2023 at around 9:30 AM, Licensing Program Analyst (LPA) L. Ibo arrived unannounced to deliver findings for the above allegation. LPA met with Administrator Rebecca Whitley and informed her the purpose of the visit.

During the course of investigation, LPA conducted records review and staff and clients/residents interview. Based on records review there was no incident report regarding clients/residents being handled in rough manner, the facility does not have incident report of any type of clients/residents bruising from an inappropriate handling of clients/resdients in care. Based on staff interview, they are not aware of any staff handling anyone roughly. Staff stated that they have not witnessed or heard any staff acting inappropriate behavior towards clients/residents in care and staff denied observing any staff yelling at the clients/residents in care.

…Continues to LIC9099C…
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
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 15-AS-20230228102849
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ELWYN CALIFORNIA - TERRA VERDE
FACILITY NUMBER: 079200634
VISIT DATE: 04/25/2023
NARRATIVE
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LPA spoke with two clients/residents in care, client (C2) stated that he is happy living at the facility and staff are nice.

LPA observed during the visit that clients/residents are comfortable, well dressed and staff are attending to each clients/residents.



Based upon the information obtained during investigation. The above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conduct and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2