197600711-12-29-2021-31-AS-NMAN-CDGU2M-20220414151209

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197600711
Report Date: 12/29/2021
Date Signed: 12/29/2021 03:40:36 PM

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
07/02/2021 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20210702144243

FACILITY NAME:	RAINBOW HORIZONS II		FACILITY NUMBER:	197600711
ADMINISTRATOR:	TRACY KENNEDY		FACILITY TYPE:	735
ADDRESS:	15917 CHASE STREET		TELEPHONE:	(818) 894-9301
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	6	CENSUS:	DATE:	12/29/2021
		UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Irene Boni, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility did not follow correct protocol.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted a subsequent visit to deliver the findings of the complaint investigation. LPA met with Irene Boni. The purpose of the visit was discussed.
It was reported that facility did not follow correct protocol. Client #1 (C1) was expressing suicidal ideation and the facility did not call 911. During the investigation on 07/08/21 between 2:20pm and 3:10pm, staff interviews were initiated. Staff interviews revealed that C1 was having a lot of anxiety on 07/01/21. C1 was given medication for anxiety. When staff was conducting a meeting with other clients, C1 walked out of the facility. Staff heard that C1 said that they did not want to live there anymore and if they did not leave then they would commit suicide. Staff asked C1 what they could do for them and they said to call the aunt. Aunt was called and came to pick up C1. C1 has not returned to the facility. LPA asked staff why C1 was not committed on a 5150 and they said that they did not think C1 was a danger to self or others. A review of C1's facility records conducted on 12/20/21 at 1:43pm, did not indicate a history of suicidal ideation. Based on interview and record review the allegation is deemed UNSUBSTANTIATED at this time. No health and safety hazards noted during this visit. Exit interview conducted and a copy of the report was issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

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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