191202146-4-3-2023-31-AS-EMIR-CTHU7B-20230707151939

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191202146
Report Date: 04/03/2023
Date Signed: 04/03/2023 02:21:43 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/29/2023 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20230329124852

FACILITY NAME:	TWELVE OAKS		FACILITY NUMBER:	191202146
ADMINISTRATOR:	DENISE M GOTTO		FACILITY TYPE:	740
ADDRESS:	2820 SYCAMORE AVE		TELEPHONE:	(818) 862-0811
CITY:	LA CRESCENTA	STATE: CA	ZIP CODE:	91214
CAPACITY:	63	CENSUS: 31	DATE:	04/03/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Denise Gotto		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are verbally & physically aggressive towards residents, which can pose a risk to their health and safety.
Staff do not provide the residents with privacy.
Staff retaliate against residents by threatening to evict them if they complain.
Staff do not provide adequate care & supervision for the residents by not meeting their incontinent needs.
Staff mishandles the residents medications.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with the administrator, Denise Gotto, and advised her of the complaint. Today's investigation consisted of interviews with staff and residents, a physical plant inspection, and record review.

Staff are verbally & physically aggressive towards residents, which can pose a risk to their health and safety:
In regards to the allegation, it was reported that Staff 1 (S1) has been very aggressive towards residents, causing these residents to sustain an injury. At approximately 10:00am to 11:30am, LPA initiated interviews with staff and resident. In the process of these interveiws, a physical plant inspection was made to insure the health and safety of the residents in care. Interviews with staff deny the allegation of staff being verbally and physically aggressive towards residents. Interview with random residents, six of six, also deny the allegation. No residents or witnesses were identified to this allegation. Based on the information obtained through interviews, there was insufficient evidence to corroborate the above allegation. Therfore, the

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230329124852

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TWELVE OAKS	FACILITY NUMBER: 191202146
	VISIT DATE: 04/03/2023

NARRATIVE

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allegation is deemed Unsubstantiated at this time.

Staff do not provide the residents with privacy:
In regards to the allegation, it was reported that staff would disclose, or "gossip" about the health of residents and other staff. There were no staff or resident names identified to the allegation. According to the administrator, resident information are confidential. There hasn't been any staff caught, while on duty, providing, or causing gossip about any resident's or staff personal information. Interviews with staff deny the allegation. Interviews with residents also do not corroborate with the allegation. Based on the information obtained, there was insufficient evidence to prove that staff are disclosing personal information of residents and staff. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff retaliate against residents by threatening to evict them if they complain:
In regards to the allegation, it was reported that if a resident complains about the administrator or staff, they would get wrongfully evicted. Interview with the administrator denies the allegation. The administrator stated there are currently no pending eviction notices that were issued. The administrator also stated that she hasn't had to issue an eviction within the last 30-60 days. Interviews with random residents also do not corroborate the allegation. Based on the information obtained, there was insufficient evidence to prove that staff retaliate against residents by threatening to evict them. Therefore the allegation is deemed Unsubstantiated at this time.

Staff do not provide adequate care & supervision for the residents by not meeting their incontinent needs:
In regards to the allegation, it was reported that staff would leave residents, who require diaper changes, wet for long hours. According to the administrator, approximately forty percent of the residents in care at her facility is incontinent. She stated each resident have their own assessment and care plan to address their incontinent care. The administrator denies the allegation of staff not meeting the resident's needs for incontinent care. At approximately 11:30am to 12:30pm, LPA, conducted a record review of random resident files to insure a care plan for incontinent care was in place. Furthermore, interviews with random residents, six of six, deny the allegation. Therefore, based on the information obtained, the allegation of staff not

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20230329124852

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TWELVE OAKS	FACILITY NUMBER: 191202146
	VISIT DATE: 04/03/2023

NARRATIVE

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providing adequate care and supervision for the residents by not meeting their incontinent needs is deemed Unsubstantiated at this time.

Staff mishandles the residents medications:
In regards to the allegation, it was reported that staff do not prepare or give any medications to the residents. Interviews with random residents, six of six deny the allegation. LPA also interviewed medication staff, who also deny the allegation of staff not preparing or administering medications for the residents. Furthermore, between 11:30am to 12:30pm, LPA conducted a record review for medications and medication records and did not observe any discrepancies with any of the residents medications. Copies of these residents medication records were also obtained for record. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff mishandling the residents medications. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

LIC9099 (FAS) - (06/04)

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