197602507-4-22-2022-29-AS-JAPL-CDV2PK-20220426173429

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602507
Report Date: 04/22/2022
Date Signed: 04/22/2022 01:56:11 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/15/2020 and conducted by Evaluator Martha Guzman-Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20200915092021

FACILITY NAME:	AVE OF THE BELLS		FACILITY NUMBER:	197602507
ADMINISTRATOR:	KAHROS, ATHINA		FACILITY TYPE:	740
ADDRESS:	5826 JUMILLA AVE.		TELEPHONE:	(818) 340-4652
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	0	CENSUS: 0	DATE:	04/22/2022
		UNANNOUNCED	TIME BEGAN:	01:34 PM
MET WITH:	Cathy Santos		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff illegally evicted resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Martha Guzman Chavez conducted a subsequent complaint visit to the above facility. The purpose of the visit is to conclude an investigation initiated by LPA A. Richardson on 9/24/2020. Facility was closed effective 02/01/2021; therefore, today’s complaint investigation was conducted telephonically at 1:35 p.m., with Administrator, Cathy Santos. Entrance interview conducted.

During the initial visit on 09/24/2020, LPA A. Richardson conducted a physical plant tour with the Administrator and House Manager at 1:30 p.m. Between 1:30 p.m. and 2:00 p.m., the LPA also conducted a telephonic interview with the House Manager and requested copies of Resident #1’s (R1’s) records.

...Continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Guzman-Chavez	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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 29-AS-20200915092021

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: AVE OF THE BELLS	FACILITY NUMBER: 197602507
	VISIT DATE: 04/22/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

...Continued from LIC 9099...

It was alleged that staff illegally evicted resident. It was reported that R1 was living in the facility but were asked to leave because the staff was frightened by them. Interviews conducted revealed R1 became upset during activities night at the facility and walked out. The Administrator tried talking to R1; however, R1 did not want to speak with them. Furthermore, interviews with R1’s family members revealed that although R1 had called to pick them up from the facility, an eviction notice was not given to either R1 or their family members. Record review revealed there was no eviction notice submitted to Community Care Licensing (CCL) for R1. Additionally, interviews revealed facility was aware of the process in order to evict a resident and did not evict R1. Based on interviews and record review, the Department does not have sufficient evidence to support the allegation of “staff illegally evicted resident”. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. A copy of report provided via email.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Guzman-Chavez	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2