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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197600711
Report Date: 03/11/2024
Date Signed: 03/11/2024 01:59:57 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
03/01/2024 and conducted by Evaluator Tihesha Smith
COMPLAINT CONTROL NUMBER: 31-AS-20240301132555
FACILITY NAME:RAINBOW HORIZONS IIFACILITY NUMBER:
197600711
ADMINISTRATOR:TRACY KENNEDYFACILITY TYPE:
735
ADDRESS:15917 CHASE STREETTELEPHONE:
(818) 894-9301
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 5DATE:
03/11/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Rosalie AlejandroTIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Staff yelled at client in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tihesha Smith conducted an unannounced complaint visit to the facility to investigate the above allegation at approximately 11:30 am. LPA met with the Administrator and explained the reason for the visit.

Allegation: Staff yelled at client in care

It was alleged that staff yelled at a client in care. To investigate this allegation, LPA Tihesha Smith conducted an interview with the administrator and requested documents relevant to the investigation at 11:44 am. There were no other staff present in the home and all residents were away at day program or at work. The administrator confirmed Resident #1 (R1) currently at work. Interview with the administrator revealed that a credible witness (CW) was on the phone with R1 and overheard and spoke with Staff #1 (S1) and expereinced S1's rude communication. Administrator also revealed Ss no longer works at facility as a result of internal investigation conducted by facilities’ corporate department.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024
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 3
Control Number 31-AS-20240301132555
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: RAINBOW HORIZONS II
FACILITY NUMBER: 197600711
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/18/2024
Section Cited
CCR
80072
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Personal Rights[…] each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature […]
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Administrator revealed will have vendor training on communication.
POC:03/1824
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This requirement has not been met as evidenced by: administrator revealed credible witness overheard and spoke with S1 about displaved ill mannered verbal communication poses a potential safety risk to this resident 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: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20240301132555
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: RAINBOW HORIZONS II
FACILITY NUMBER: 197600711
VISIT DATE: 03/11/2024
NARRATIVE
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(Cont from 9099)

Based on the information obtained this allegation is deemed Substantiated at this time.

Deficiency cited on LIC 9099D.

Exit Interview conducted. Appeal Rights explained. Copy of report given.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3