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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197600690
Report Date: 11/23/2022
Date Signed: 11/23/2022 02:03:46 PM

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
12/21/2021 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20211221102842
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: 5DATE:
11/23/2022
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Johanna Bonilla, Residential AideTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
 Lack of supervision resulting in resident leaving the facility.

Facility has inadequate staffing.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted a subsequent visit in order to deliver the findings for the above noted allegations. LPA met with Residential Aide, Johanna Bonilla and discussed the purpose of the visit.

It was reported that lack of supervision resulted in a resident leaving the facility. To investigate this allegation on 12/29/2021, between 12:30pm and 1:30pm, staff interviews were initiated. Interviews revealed that on 11/14/2021, Resident #1 (R1) had jumped over the neighbor's wall. On 11/14/2021, three staff were scheduled for the 3pm-11pm shirt, but only two staff were present. On 11/14/2022, between 11:00am and 12:30pm, LPA reviewed records. Records reviewed were the Corrective Action Plan (CAP) from the Regional Center and R1's IPP. Documents confirmed what staff had told LPA and it was also noted that R1 has an assigned one on one. On 11/14/2021, R1 was left unattended by their one on one, resulting in R1 eloping from the facility.
See 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022
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-20211221102842
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: 11/23/2022
NARRATIVE
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Based on interviews and records review there is sufficient information to support this allegation. Therefore, this allegation is being SUBSTANTIATED at this time.

It was alleged that the facility has inadequate staffing. To investigate this allegation on 12/29/2021, between 12:30pm and 1:30pm, staff interviews were initiated. Interviews revealed that a staff member from the Regional Center conducted an unannounced visit to the facility on 12/03/2021. Staff from Regional Center observed three clients and only one staff member present on that day. R1 was having a behavioral episode on 12/03/2021. Facility staff contacted the administrator, but due to illness they were unable to go. Another staff, not scheduled for that day, arrived later to assist. On 11/14/2022, between 11:00am and 12:30pm, LPA reviewed records. Records reviewed confirmed what staff had told LPA. In addition, it was noted that two (02) out of three (03) clients required a one on one according to their IPPs.

Based on interviews and records review there is sufficient information to support this allegation. Therefore, this allegation is deemed to be SUBSTANTIATED at this time.

Deficiencies cited per Title 22 Regulations.

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

DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20211221102842
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: 11/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/23/2022
Section Cited
CCR
80078(a)
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80078(a) Responsiblity for Providing Care and Supervision- The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement was not met as evidenced by:
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POC cleared on this visit. Facility was issued a Corrective Action Plan from the Regional Center, in which the facility fulfilled the required obligations in the CAP.
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Based on interviews and record review the Licensee did not ensure that there was adequate care and supervision being provided to R1. As a result, R1 eloped from the faciltiy.

This poses an immediate health and safety risk to clients in care.
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Type A
11/23/2022
Section Cited
CCR
80065(a)
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80065(a) Personnel Requirements- Facility shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.

This requirement was not met as evidenced by:
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POC cleared on this visit. Facility was issued a Corrective Action Plan from the Regional Center, in which the facility fulfilled the required obligations in the CAP.
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 Based on interviews and record review the Licensee did not ensure that all scheduled facility staff were present on their assigned shift. This resulted in there not being sufficient staff to provide the necessary needs of individual clients who require one on one supervision. This poses an immediate health and safety risk 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: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
12/21/2021 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20211221102842

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:
11/23/2022
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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2
3
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5
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9
Substitute administrator does not meet the qualifications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted a subsequent visit in order to deliver the findings for the above noted allegations. LPA met with blank and discussed the purpose of the visit.

It was reported that Substitute administrator does not meet the qualifications. To investigate this allegation on 12/29/2021, between 12:30pm and 1:30pm, staff interviews were initiated. Staff interviews revealed that the designated staff to assist the administrator in their absence do met the qualifications. On 11/14/2022, between 11:00am and 12:30pm, LPA reviewed records. Records revealed that staff do meet the qualifications, but that the facility had not completed the licensing form designating them.

Based on interviews and records review, there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4