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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197600690
Report Date: 09/16/2021
Date Signed: 09/16/2021 10:48:20 AM

Substantiated


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
09/18/2020 and conducted by Evaluator Tuesday Cabiness
COMPLAINT CONTROL NUMBER: 31-AS-20200918170027
FACILITY NAME:THERAPEUTIC LIVING CENTERS FOR THE BLINDFACILITY NUMBER:
197600690
ADMINISTRATOR:HITZ, JADEFACILITY TYPE:
735
ADDRESS:17712 PARTHENIATELEPHONE:
(818) 349-3440
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:6CENSUS: DATE:
09/16/2021
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Thosha DavisTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff left resident's unsupervised
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness met with Lead Staff Thosha Davis and informed her the reason of the visit. Staff contacted House Manager Correthia Mitchell, who LPA spoke to over the phone and inforned her the reason of the visit. Administrator Joshua Cration was not available and was on vacation. LPA visited the facility to deliver the final findings of the allegation mentioned above.

It was alleged that staff left residents unsupervised. During the investigation, from 09/16/2020 through 09/29/2020, from various times, ranging from 11am to 4pm, LPA conducted interviews, and reviewed documents. Also, on 06/25/2021 and 09/13/2021, from various times, ranging from 9am to 5pm, LPA re-reviewed the complaint and documents pertaining to the complaint. It was revealed, that on that on 08/28/2020, a third-party provider reported that group home staff left the facility from 3pm to 314pm, while residents were at the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
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-20200918170027
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: THERAPEUTIC LIVING CENTERS FOR THE BLIND
FACILITY NUMBER: 197600690
VISIT DATE: 09/16/2021
NARRATIVE
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The third-party staff was providing 1:1 service for only (1) resident, and not the remaining (4) residents that were at the facility. The group home staff that exited the facility, did not communicate to the house manager or Administrator that staff was leaving, and left the third-party provider alone with residents. An incident report was submitted to NLACRC (North Los Angeles County Regional Center) regarding the incident. On 09/16/2020, a meeting was conducted with Regional Center personnel and facility staff, and the Administrator confirmed staff left the facility with the third-party provider and did not properly communicate to Administration that the staff was leaving the facility for the day. A CAP (Corrective Action Plan) was issued to the facility by Regional Center for non-compliance. This is a potential health and safety risk to residents in care. Therefore, based on interviews and documents reviewed, the allegation, “Staff left residents unsupervised” is SUBSTANTIATED.

Citation issued, POC cleared, exit interview and copy of report was signed by lead staff Tasha Davis. Report was emailed to Administrator and House Manager.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20200918170027
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: THERAPEUTIC LIVING CENTERS FOR THE BLIND
FACILITY NUMBER: 197600690
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2021
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision as necessary to meet the client's needs.
This requirement was not met, evidenced by; during interviews and
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POC cleared. Administrator was issued an Corrective Action Plan with Regional Center, in which the facility fulfilled the required obligations in the CAP. LPA received the removal letter
that the CAP was in compliance.
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documents obtained, it was confirmed by the Administrator that a group home staff left clients with the third-party staff for (14) minutes, without notifiying Administration. This is a potential health and safety risks to clients 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: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
LIC9099 (FAS) - (06/04)
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