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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191290706
Report Date: 09/16/2024
Date Signed: 09/16/2024 03:25:05 PM

Substantiated


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
02/01/2024 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20240201141701
FACILITY NAME:HAMILTON HOUSEFACILITY NUMBER:
191290706
ADMINISTRATOR:PETERSON, JANICEFACILITY TYPE:
735
ADDRESS:739 W. GLENOAKS BLVD.TELEPHONE:
(818) 502-9188
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY:11CENSUS: 4DATE:
09/16/2024
UNANNOUNCEDTIME BEGAN:
11:19 AM
MET WITH:Kathy Solorzano, Facility RepresentativeTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility does not provide a resident with activities.

Staff speaks to a resident in an aggressive manner.
INVESTIGATION FINDINGS:
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This is an addendum to a report previously issued on 02/08/2024. Due to computer issues the complete final report was not able to be delivered.

Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegations. LPA met with Facility Representative Kathy Solorzano and explained the reason for the visit.

It was reported that facility does not provide a resident with activities. To investigate this allegation on 2/08/2024, LPA conducted file review before going to the facility. Between 9:00am and 9:30am, LPA reviewed facility files and saw a monthly activity schedule and a program schedule from 30 years ago. LPA could not find an updated activity schedule on file. Between 2:00pm to 3:00pm, staff interviews were initiated. Interviews revealed that currently the facility is not offering its residents any activities. In addition,

Continue on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
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 3
Control Number 31-AS-20240201141701
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: HAMILTON HOUSE
FACILITY NUMBER: 191290706
VISIT DATE: 09/16/2024
NARRATIVE
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LPA did not observe any activity board posted on the facility walls. Staff told LPA that a couple of years ago activities were provided, but that with the change of administrators the activities came to a halt. Furthermore, between 3:00pm and 4:00pm, resident interviews were initiated. Four out of seven residents that were present at the time of the visit were interviewed. Interviews confirmed what staff had told LPA. The facility is not providing any activities to residents in care. Residents interviewed stated that they are bored and have nothing to do.

Based on interviews, record review, and observation, there is sufficient information to support this allegation.
Therefore, this allegation is SUBSTANTIATED at this time.

It was alleged that staff speaks to a resident in an aggressive manner. To investigate this allegation between 2:00pm and 3:00pm, staff interviews were initiated. Interviews revealed that Staff #2 (S2) does speak aggressively towards Resident #1 (R1) especially when they complain about something in the facility. Between 3:00pm and 4:00pm, three out of seven residents present at the facility at the time of this visit were interviewed. Interviews confirmed what was reported to LPA. Residents expressed a sense of fear and unwillingness to discuss problems at the facility due to retaliation. Moreover, on a prior visit LPA observed S2 speaking to R1 in an aggressive and defensive manner.

Based on interviews and observation, there is sufficient information to verify this allegation. Therefore, this allegation is SUBSTANTIATED at this time.

Exit interview conducted and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20240201141701
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: HAMILTON HOUSE
FACILITY NUMBER: 191290706
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2024
Section Cited
CCR
85079(a)
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85079-Activities-(a) The licensee shall ensure that planned recreational activities ,...
are provided to the clients.

This requirement was not met as evidenced by:
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The Licensee shall submit an updated activities schedule to licensing by 9/30/24 and will explain how they will ensure that clients are provided activities.
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Based on interviews of both staff and clients and record review, the Licensee ceased offering activities to clients.

This poses a potential health and safety risk to clients in care.
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Type B
09/30/2024
Section Cited
CCR
80072(a)(1)
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80072 (a)(1) Personal Rights-..each client shall have personal rights which include...to be accorded dignity in his/her personal right with staff and other persons.
This requirement was not met as evidenced by:
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The Licensee shall submit in writing to licensing by 09/30/2024, how they will ensure that all clients in care are accorded with dignity in his/her personal rights and interactions with staff.
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 LPA observed Staff #2 speaking in a condescending and aggressive manner to a client. Also four out of seven clients interviewed also confirmed that staff is intimidating and rude.
This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC9099 (FAS) - (06/04)
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