<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197600716
Report Date: 05/23/2022
Date Signed: 05/23/2022 03:44:41 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
05/03/2022 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20220503123845
FACILITY NAME:VISTAS HOMEFACILITY NUMBER:
197600716
ADMINISTRATOR:JASSO,CARLOSFACILITY TYPE:
735
ADDRESS:16778 OTSEGO ST.TELEPHONE:
(818) 784-1680
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY:4CENSUS: 4DATE:
05/23/2022
UNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Carlos JassoTIME COMPLETED:
03:57 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff abandoned resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Abeye Duguma conducted a subsequent complaint visit to investigate the above allegations. LPA met with the Administrator, Carlos Jasso, and explained the reason for the visit.

It was alleged that facility refused to pick up the resident. To investigate this allegation, on 05/04/2022, LPA interviewed staff from 10:30 AM - 11:30 AM. During the interview, it was discovered that the hospital requested more than once that the resident be picked up, that the facility refused more than once to pick up the resident and that, although the resident was eventually picked up, the facility did not do it in a timely manner. Furthermore, an eviction notice was given on 05/06/2022 and the resident was taken to the hospital on 05/02/2022 and picked up 05/03/2022.

Based on the information revealed during interviews, the allegation is SUBSTANTIATED at this time.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
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 2
Control Number 31-AS-20220503123845
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: VISTAS HOME
FACILITY NUMBER: 197600716
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/27/2022
Section Cited
CCR
85068.5
1
2
3
4
5
6
7
(a)The licensee shall be permitted to evict a client by serving the client with a 30-day written notice to quit for any of the following..:(4) A needs and services plan modification has been performed.. which determined that client's needs cannot be met.. and the client has.. an opportunity to relocate.
1
2
3
4
5
6
7
The Administrator will review Section 85068.5 Eviction Procedures and will provide a written letter stating how the facility will adhere to the regulation.
8
9
10
11
12
13
14
This requirement is not met as evidenced by; Based on interviews, the facility did not issue a 30-day written notice to quit based on not being able to meet the client’s needs and give opportunity to relocate. This poses a potential Health, Safety orPersonal Rights risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2