191220171-8-26-2024-31-AS-NGID-D8LUYD-20240829155947

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191220171
Report Date: 08/26/2024
Date Signed: 08/26/2024 03:43:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
05/12/2023 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20230512112037

FACILITY NAME:	THERAPEUTIC LIVING CENTERS FOR THE BLIND		FACILITY NUMBER:	191220171
ADMINISTRATOR:	SANDOVAL,JUAN		FACILITY TYPE:	775
ADDRESS:	7955 LINDLEY AVENUE		TELEPHONE:	(818) 708-4940
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	90	CENSUS: 90	DATE:	08/26/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Juan Sandoval, Administrator		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff did not provide adequate supervision to client(s) while in care.
Staff are not meeting client(s) need.

INVESTIGATION FINDINGS:

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At 09:30 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent complaint visit. LPA met with the Administrator, Juan Sandoval and explained the reson for the visit.

A subsequent visit was conducted on 08/19/2024. During course of the investigation, interviews and record review were made. At 9:55 AM, LPA requested resident and staff roster. At 10:00 AM, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, etc., relevant to the investigation. At approximately 10:05 AM, LPA conducted a physical plant tour. Between 10:15 AM to 1:45 PM, LPA conducted an interview with the Administrator, one staff (S1) one Qualified Intellectual Disability Professional (QIDP), and ten (10) clients who were able to communicate. Additional interviews and record reviews were also conducted during today’s visit.

Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

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-20230512112037

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: THERAPEUTIC LIVING CENTERS FOR THE BLIND	FACILITY NUMBER: 191220171
	VISIT DATE: 08/26/2024

NARRATIVE

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Staff did not provide adequate supervision to client(s) while in care.
It was reported that Client #1 (C1) had a bump on his/her right cheek, below the cheek area and upper eyebrow area, at the Day-Program due to the lack of supervision or neglect. To investigate this allegation, LPA conducted an interview with the Administrator and was informed that C1 was always assisted or supervised by at least one staff due to their health condition. Moreover, upon C1’s arrival to the facility on 05/04/2023, the staff noticed the bruise on C1 face and immediately applied ice and notified the Artistic Director. Interview with the Artistic Director revealed that C1’s did not allow an ice treatment to be provided. Interview also revealed that C1’s Power of Attorney (POA) was immediately notified and the facility attempted to call 911, however, C1’s POA on medical decision making refused 911 services to be provided. Later that day, when C1 was taken back to the Shoup House, C1 was taken to ER. LPA conducted Review of Medical Records and did not observe serious injury reported by the physician during ER visit on 05/04/2023. Based on the interviews and record review this allegation is Unsubstantiated at this time.

Staff are not meeting client(s) need:
It was reported that the staff are not meeting C1's needs. To investigate this allegation, LPA conducted an interview with the Administrator, and it was revealed that the facility staff always provides client’s needs. Although C1 refused first aid attention provided by the facility, the staff attempted to apply ice on C1’s bruises. Furthermore, facility also notified the Shoup House Coordinator to provide medical assessment to C1’s bruises by the house nurse. Based on interviews this allegation is Unsubstantiated at this time.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

LIC9099 (FAS) - (06/04)

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