197602726-10-13-2023-29-AS-KHEN-CX5PEB-20231031111453

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602726
Report Date: 10/13/2023
Date Signed: 10/13/2023 12:00:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
04/05/2022 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20220405114844

FACILITY NAME:	ETTA ISRAEL CENTER ADULT RESIDENTIAL #1		FACILITY NUMBER:	197602726
ADMINISTRATOR:	HEIDI SCHOFIELD		FACILITY TYPE:	735
ADDRESS:	5520 WORTSER AVENUE		TELEPHONE:	(818) 785-2054
CITY:	SHERMAN OAKS	STATE: CA	ZIP CODE:	91401
CAPACITY:	6	CENSUS: 6	DATE:	10/13/2023
		UNANNOUNCED	TIME BEGAN:	10:07 AM
MET WITH:	Eduardo Briseno, House Manager		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Resident(s) are not accorded dignity in their personal relationships with staff and other persons.
Staff do not assist residents with incontinence needs.
Staff failed to provide necessary personal assistance and care with activities of daily living including but not limited to dressing, eating, and bathing.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi, conducted an unannounced subsequent visit to deliver findings at this facility. At 10:07 a.m., the LPA spoke with the Administrator over the telephone and explained the reason for the visit. The Administrator was unable to meet the LPA during the time of the visit, however authorized the House Manager to sign the report.

During an initial visit on 04/13/2022, between 9:50 a.m. and 3:40 p.m., LPA Peraldi conducted a physical plant tour, reviewed records, interviews six (6) out of six (6) clients and three (3) staff. During a subsequent visit on 12/19/2022, between 9:35 a.m. and 4:30 p.m., LPAs Peraldi and Smith conducted a physical plant tour and conducted interviews with two (2) staff and one (1) client. On 12/29/2022 and 01/05/2023 LPA Peraldi interviewed four (4) clients’ family members.

Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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 29-AS-20220405114844

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ETTA ISRAEL CENTER ADULT RESIDENTIAL #1	FACILITY NUMBER: 197602726
	VISIT DATE: 10/13/2023

NARRATIVE

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Regarding the allegations: Staff failed to provide necessary personal assistance and care with activities of daily living including but not limited to dressing, eating, and bathing. Staff do not assist residents with incontinence needs. It was alleged that staff do not assist clients with their incontinence needs and with activities of daily living (ADLs). Interviews with the Administrator and staff revealed that clients are independent and are able to conduct ADLs with very little assistance. The Administrator explained that staff do assist clients with their ADLs if needed. Interviews revealed that each client has their own needs, and their care is coordinated to meet each individual’s needs. Interviews with various clients’ family members did not reveal concerns regarding staff neglect. Additionally, client interviews did not reveal any issues regarding staff neglect and indicated that client needs are being met. The information obtained during the investigation did not include evidence sufficient to corroborate the allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed Unsubstantiated at this time.

Regarding the allegation: Resident(s) are not accorded dignity in their personal relationships with staff and other persons. It was alleged that staff antagonized Client #1 (C1) in front of the other clients.The complainant did not specify which staff antagonized C1. Interviews with the Administrator revealed that all staff and C1 have a good relationship with each other and that there hasn't been any issues. Interviews with staff denied the mistreatment of C1. Interview conducted with C1 revealed they get along with facility staff and have no issues with staff. Additionally, an interview with C1’s family member revealed that C1 is happy to be at the facility. Client interviews did not reveal concerns regarding staff. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

No deficiencies were observed. Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC9099 (FAS) - (06/04)

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