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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191290706
Report Date: 05/06/2024
Date Signed: 05/06/2024 01:59:30 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
04/29/2024 and conducted by Evaluator Gina Saucedo
COMPLAINT CONTROL NUMBER: 31-AS-20240429094201
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: 6DATE:
05/06/2024
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:George MannieTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff are not adequately supervising residents resulting in health and safety concerns
Staff did not properly log resident's blood pressure
Staff did not ensure residents medication was propery stored
Staff are not providing a comfortable environment for residents
INVESTIGATION FINDINGS:
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On 05/06/24, at 10:05am, Licensing Program Analysts (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Caregiver, Kathy Solorzano. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather information, conduct interviews and deliver findings for this complaint.

The investigation consisted of the following: LPA Saucedo asked for the census, client and staff roster. At 11:20am, LPA toured the physical plant. During the tour, LPA interviewed five (5) clients and three (3) staff were interviewed.

9099C-continued
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024
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 4
Control Number 31-AS-20240429094201
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: 05/06/2024
NARRATIVE
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Regarding the allegation: Staff are not adequately supervising clients resulting in health and safety concerns. It is being alleged that there was a fire in the kitchen area resulting in a spoon being burned by one (1) of the clients that was cooking unsupervised. Five (5) out of six (6) clients were interviewed and confirmed that the kitchen area was on fire. One (1) clients observed the spoon burning and observed another client turn off the stove while the staff was no where around the area in which this occurred. One (1) staff confirmed the following day the fire department did a wellness check to check on the above facility. Based on the staff and client interviews the above allegation(s) is found to be SUBSTANTIATED.

Regarding the allegation: Staff did not properly log client's blood pressure. It is being alleged that staff wrote down the client’s blood pressure on a piece of paper instead of a logbook in which it should be kept. LPA was able to observe and take pictures of the medication log book that keeps track of April/May Blood Pressure. The blood pressure for April 26th is missing on the PM blood pressure logbook, it was not documented for the client. One (1) of the staff verified that the client's blood pressure has to be taken and documented everyday. Based on LPA’s observations, staff, and client interviews the above allegation(s) is found to be SUBSTANTIATED.

Regarding the allegation: Staff did not ensure client's medication was properly stored. It is being alleged that the medication and soap cabinets are left open. Five (5) out of six (6) clients were interviewed and confirmed that the medication and soap cabinets are left open. Based on client interviews the above allegation(s) is found to be SUBSTANTIATED.

Regarding the allegation: Staff are not providing a comfortable environment for residents. It is being alleged that the staff wear inappropriate clothing. Five (5) out of six (6) clients were interviewed and confirmed that the staff wear inappropriate clothing. Two (2) out of three (3) staff confirmed that the staff wear inappropriate clothing. Based on staff and client interviews the above allegation(s) is found to be SUBSTANTIATED.

An exit interview was conducted, citations were issues, appeal rights, and a copy of this report was given to the administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20240429094201
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: 05/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/07/2024
Section Cited
CCR
80065(f)(3)
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80065(f)(3) Personnel Requirements (f) All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance. (3) Provision of client care and supervision, including communication. This requirement is not met as

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The administrator/Licensee must provide training to the staff and clients about fire safety and the importance of client care and staff supervision. POC 05/07/24
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Based on the client interviews the staff did not ensure the safety of the client at the facility inregards to fire safety and proper supervision which poses an immediate Health, Safety or Personal Rights risks to persons in care.
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Type A
05/07/2024
Section Cited
CCR
80069(d)(4)
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80069 (d)(4) Client Medical Assessment the medical assessment for clients in ARFs shall include the following: Current medical status including, but not limited to, height, weight, and blood pressure. This requirement is not met as
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The administrator/Licensee must document the client's blood pressure eveyday on the blood pressure logbook both am and pm. In addition, training has to be provided and sent to LPA about the importance of client medical assessment. POC 05/07/24
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Based on the LPAs observation, record review and interviews the staff did not ensure the safety of the client at the facility inregards to their medical needs which poses an immediate Health, Safety or Personal Rights risks to persons 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: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20240429094201
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: 05/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/07/2024
Section Cited
CCR
80075(k)(1)
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80075(k)(1) Health Related Services (k) The following requirements shall apply to medications which are centrally stored:
(1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as


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The administrator/Licensee must document and provide training to the staff about the safety of medication and soaps being locked and inaccessible to clients and send to LPA.
POC 05/07/24
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Based on the LPA's interviews the staff did not ensure the safety of the client at the facility inregards to the medication being locked and inaccessible to the clients which poses an immediate Health, Safety or Personal Rights risks to persons in care.
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Type B
05/28/2024
Section Cited
CCR
80072(a)(1)
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80072(a)(1) Personal Rights ....each client shall have personal rights which include, but are not limited to, the following: (1)To be accorded dignity in his/her personal relationships with staff and other persons. This requirement is not met as


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The administrator/Licensee must document and provide training to the staff about personal rights and their personal relationships with staff and send to LPA.
POC 05/28/24
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Based on the LPA's interviews the staff did not ensure the personal rights of the client at the facility inregards to the which poses an potential Health, Safety or Personal Rights risks to persons 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: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4