197602726-10-13-2023-29-AS-KHEN-CX5PKE-20231031112302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602726
Report Date: 10/13/2023
Date Signed: 10/13/2023 11:54:33 AM

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
12/12/2022 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20221212134446

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:	10:06 AM
MET WITH:	Eduardo Briseno, House Manager		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff is not meeting resident's grooming needs.

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 the initial 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-20221212134446

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 allegation: Staff is not meeting resident's grooming needs. It was alleged that clients were not being groomed as needed. Interviews with the Administrator and staff revealed that clients are able to groom themselves. The Administrator explained that staff do assist and remind clients to groom themselves throughout their morning routines and night routines. During the physical plant tour on 12/19/22, the clients appeared well groomed. Interviews with various clients’ family members did not reveal concerns regarding staff not meeting clients grooming needs. Additionally, client interview did not reveal any issues with their grooming needs not being met. 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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