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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197601249
Report Date: 10/29/2024
Date Signed: 10/29/2024 12:52:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
11/28/2023 and conducted by Evaluator Antonia Alvizar-Ettima
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20231128103004
FACILITY NAME:ADULT BASIC LEARNING ENVIRONMENT, INCFACILITY NUMBER:
197601249
ADMINISTRATOR:ROBERT MARTINEZFACILITY TYPE:
775
ADDRESS:204 N. VICTORY BLVD.TELEPHONE:
(818) 842-4933
CITY:BURBANKSTATE: CAZIP CODE:
91502
CAPACITY:30CENSUS: 12DATE:
10/29/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Director, Sheri GlendenningTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff caused injury to resident
Staff did not provide medical attention to resident
INVESTIGATION FINDINGS:
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At 9:45a.m. Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced subsequent complaint visit to continue investigation and deliver the finding for the above stated allegations. LPA met with the Direct Support Professional (DSP's), Andrew Mayes, Nikol Byrne, Ada Fuentes and Asher Romano and explained the reason for the visit. Byrne called Director via-phone arrived at 10:55a.m. and joined us.

An initial complaint visit conducted on 12/05/23 at approximately 10:30 a.m. LPA Alvizar-Ettima and designated staff, Maryland Delgado conducted a physical plant tour. At the time of the inspection, three (03) staff, two (02) out of six (06) clients including client #1 (C1) were interviewed. In addition, at 11:30a.m., LPA requested copies of pertinent documents relevant to the investigation.

1. Staff caused injury to resident.

Cont. on LIC 9099c
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
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 2
Control Number 31-AS-20231128103004
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ADULT BASIC LEARNING ENVIRONMENT, INC
FACILITY NUMBER: 197601249
VISIT DATE: 10/29/2024
NARRATIVE
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It was alleged that staff dropped client (C1) when transferring from bed to wheelchair. LPA conducted interviews with two (02) staff (S1-S2) and manager that where present on the day of the incident. Staff interviews revealed that C1 and S1 both fell during transfer from changing bed to wheelchair. However, C1 was not hurt and had no injuries. Interview of C1 confirm that the fall was an accident and C1 did not get hurt. At the time of this visit, LPA attempt to interview six (06) out of twelve (12) clients, however LPA was able to interview two (02) out of six (06) clients due to other clients being non-verbal. The two (02) clients interviewed had no concerns about staff assistance, and they were never hurt and injured during staff assistance. During investigation, LPA did not observe injured clients in the facility. LPA Alvizar - Ettima reviewed Special Incident Report, regarding C1’s fall. The report verified the information received from facility staff.

Based on observation, interviews and record review there is no pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

2. Staff did not provide medical attention to resident. It was alleged that staff did not provide medical attention to client (C1) when sustained a fall resulting swollen left arm. During investigation staff revealed that after the incident they assess C1 and C1 denied any injuries or pain. Staff attempt to call 911. However, C1 refused emergency services. During interview C1 indicated that staff at the facility and at home did provide medical attention. C1 was assessed for pain and injury. Staff interview revealed that C1 was asked if they needed to go to the hospital and C1 refused. At the time of this visit, LPA attempt to interview six (06) out of twelve (12) clients, however LPA was able to interview two (02) out of six (06) clients due to other clients being non-verbal. The two (02) clients interviewed revealed the that staff always provides medical attention as needed. LPA Alvizar - Ettima reviewed Observation Report, regarding C1’s fall. The report verified the information received from facility staff.

Based on observation, interviews and record review there is no pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview was conducted. Copy of this record provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2