191290706-8-31-2023-28-AS-MVAO-CWQVUS-20231018164514

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290706
Report Date: 08/31/2023
Date Signed: 08/31/2023 11:24:40 AM

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
02/10/2023 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 28-AS-20230210144317

FACILITY NAME:	HAMILTON HOUSE		FACILITY NUMBER:	191290706
ADMINISTRATOR:	PETERSON, JANICE		FACILITY TYPE:	735
ADDRESS:	739 W. GLENOAKS BLVD.		TELEPHONE:	(818) 502-9188
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91202
CAPACITY:	11	CENSUS: 7	DATE:	08/31/2023
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Nichole Isabelo, Staff		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Staff did not safeguard resident personal belongings.
Staff are not providing a safe environment for resident

INVESTIGATION FINDINGS:

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At 10:40am, Licensing Program Analyst (LPA) Angela Panushkina conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA met with Nichole Isabelo, Staff #1 (S1), who granted access to the facility. LPA contacted the Administrator and explained the purpose of the visit. Administrator infomred LPA that he won't be able to come to the facility and designated S1 to sign the final report.

The investigation consisted of the following: on 02/15/2023 LPA Panushkina initiated a complaint investigation. At 11:15am LPA toured the physical plant and conducted interviews with the Administrator, two (2) staff members and four (4) out of nine (9) clients. LPA also requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s report, Appraisal Needs and Services Plan, Resident Appraisal, etc., relevant to the investigation. On 03/20/2023, LPA Agard conducted a subsequent visit for additional interviews. At the time, due to time constraints, the need to
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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 28-AS-20230210144317

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: HAMILTON HOUSE	FACILITY NUMBER: 191290706
	VISIT DATE: 08/31/2023

NARRATIVE

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collect and analyze additional information, further investigation was needed.

Allegation: Staff did not safeguard resident personal belongings.

The investigation revealed the following: Regarding the allegation… Staff did not safeguard resident personal belongings. It’s being alleged a client’s personal property was stolen and the facility was negligent in the process of finding said stolen item. Interviews were conducted with three (3) staff members. It was determined C1 is responsible for the said missing personal belonging and may have lost it. It is unclear to all interviewees if the item was misplaced or stolen but assistance was offered to C1 to locate the missing item. C1 was transported to the last know location via S3 and was unable to locate the item. The facility assisted C1 with filing a police report. LPA interviewed six (6) clients out of nine (9). One (1) client was unavailable for an interview, two (2) clients were unaware of C1’s missing item, two (2) clients denied taking C1’s property. It was determined that C1’s lost item had been replaced.

Allegation: Staff are not providing a safe environment for resident

The investigation revealed the following: Regarding the allegation… Staff are not providing a safe environment for resident. It’s being alleged a client is being bullied by another client in the facility. LPA conducted interviews with 3 staff who all denied clients being bullied by one another. LPA conducted interviews with clients and four (4) of the six (6) clients interviewed were unable to confirm the validity of the allegation. C1 acknowledged having a mutual friendship with the accused perpetrator, negating the allegation.

Based on LPA’s record review and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are Unsubstantiated.

No deficiencies issued.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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