197601724-1-16-2024-31-AS-MVAO-D26SAK-20240205124227

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197601724
Report Date: 01/16/2024
Date Signed: 01/16/2024 02:20:40 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
01/08/2024 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20240108151253

FACILITY NAME:	RINALDI GUEST HOME		FACILITY NUMBER:	197601724
ADMINISTRATOR:	MARILYN ACABAL		FACILITY TYPE:	740
ADDRESS:	16016 RINALDI STREET		TELEPHONE:	(818) 831-6602
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 6	DATE:	01/16/2024
		UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Clyde Agabal		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Licensee did not comply with the terms and condition of Admission Agreement.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. It was reported that a regularly annual visit was made on or around October 27, 2023, and at the time of that review, the facility lacked the required documentation to support staff training and resident services. Today's investigation consisted of interviews with staff and residents, and a record review of six (6) resident records and two (2) staff records. In addition, LPA also conducted a plant inspection to insure the health and safety of the residents in care.

Although the licensee has began to comply with regulation, and is curretnly working on their Corrective Action Plan (CAP) to satisfy their record keeping for staff training and resident services, the above allegation is Substantiated based on the Annual Review that was made on or around October 27, 2023. Citations issued on the 9099D. Exit interview conducted. A copy of this report and appeal right issued.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

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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Control Number 31-AS-20240108151253

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: RINALDI GUEST HOME	FACILITY NUMBER: 197601724
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/16/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/23/2024 Section Cited CCR 80065(f)	1 2 3 4 5 6 7	Personnel Requirements: All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance. This requirement was not met	1 2 3 4 5 6 7	The licensee was given a corrective action plan (CAP) to comply with Title 17 section 56054, due by 01/20/24. As POC, the licensee will submit a copy of that CAP, to confirm that S1 has satsified their continuing education, to the licensing agency by January 23, 2024.
	8 9 10 11 12 13 14	as evidenced by: An annual review made on or around 10/27/23. At the time of that review, direct care staff, staff 1 (S1) failed to meet continuing education units from their hire date. This poses a potential health and safety risk to the resident in care.	8 9 10 11 12 13 14
Type B 01/23/2024 Section Cited CCR 80070(a)	1 2 3 4 5 6 7	Client Record: The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client. This requirement was not met as evidenced by: An annual review made on or around 10/27/23. At the time of that review, there was no documentation available to support	1 2 3 4 5 6 7	The licensee was given a corrective action plan (CAP) to comply with Title 17 section 56054, due by 01/20/24. As POC, the licensee will submit a copy of that CAP to the licensing agency by January 23, 2024.
	8 9 10 11 12 13 14	the services, nor hours provided to the residents. This poses a potential health and safety risk to the residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

LIC9099 (FAS) - (06/04)

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