191202190-5-5-2021-28-AS-LHIS-C6QUYC-20210910155943

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191202190
Report Date: 05/05/2021
Date Signed: 05/05/2021 05:41:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2021 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210426102102

FACILITY NAME:	WINDSOR		FACILITY NUMBER:	191202190
ADMINISTRATOR:	CAMERON, LEIF J		FACILITY TYPE:	741
ADDRESS:	1230 EAST WINDSOR ROAD		TELEPHONE:	(818) 244-7219
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	175	CENSUS: 87	DATE:	05/05/2021
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Yvette Duarte		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Illegal Eviction
Staff yelled at Resident
Facility in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea initiated a complaint investigation for the allegation(s) listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Executive Director, Yvette Duarte.

The investigation consisted of the following : interview(s) with administrator, Staff #1- Staff #2, Resident #1 - Resident #6, review of specific documents from resident #1's file, and tour of facility. Regarding the allegation that Resident #1 is being illegally evicted. The investigation revealed the following: Resident #1 received an eviction notice on 4/6/21. LPA reviewed the eviction notice and observed that it was in compliance with Title 22 Regulations. However, LPA reviewed documentation that Resident #1 has provided the facility with a written notice dated 5/4/21, indicating that she plans to move out of the facility on 7/15/21. Executive director stated that the facility will amend the eviction notice, and has agreed to allow Resident #1 to stay at the facility until that date.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2021

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 28-AS-20210426102102

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WINDSOR	FACILITY NUMBER: 191202190
	VISIT DATE: 05/05/2021

NARRATIVE

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Regarding the allegation that staff yelled at Resident #1, the investigation consisted of interview(s) with Executive Director, Staff #1- Staff #2, Resident #1 - Resident #6. Executive Director, and staff interviewed denied the allegation. Staff interviewed stated that they never yell at residents, nor have they observed any staff yell at residents. Residents interviewed were unable to corroborate the allegation. 5 out of 6 Residents interviewed stated that they have never observed staff yell at any residents.

Regarding the allegation that the facility is in disrepair. The investigation consisted of the following : interview(s) with Executive Director, Staff #1- Staff #2, Resident #1 - Resident #6, and tour of facility. Executive Director assisted with virtual tour of facility. LPA observed that the facility is in good repair. Staff interviewed denied the allegation. Residents interviewed were unable to corroborate the allegation. They stated that the facility is in very good repair.

Based on LPA's observations and interviews, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. An exit Interview was conducted via telephone with the Executive Director and a hardcopy was provided via email for signature. Signatures on hardcopy.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2021

LIC9099 (FAS) - (06/04)

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