197603652-6-4-2021-31-AS-MVAO-C4NMH3-20210706093648

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603652
Report Date: 06/04/2021
Date Signed: 06/04/2021 02:24:42 PM

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
05/28/2021 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20210528144909

FACILITY NAME:	AMBASSADOR GARDEN		FACILITY NUMBER:	197603652
ADMINISTRATOR:	SOFI DRUKER		FACILITY TYPE:	740
ADDRESS:	7324 CANBY AVENUE		TELEPHONE:	(818) 705-3404
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	158	CENSUS:	DATE:	06/04/2021
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Sofi Druker/ Administrator		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Staff handled resident in rough manner.

Staff made verbal threats to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility and was greeted by the facility administrator. LPA explained the reason for the visit.
At 11:20 am, LPA requested a copy of the LIC 500 and a resident roster. At 11:30am, LPA began touring the facility. At 11:50am, LPA began interviewing residents and staff. LPA was able to interview 10 residents and 4 staff members regarding the allegations.

Allegation 1. Staff handled resident in a rough manor.
LPA began a facility tour at about 11:50am. LPA was able to speak with 10 residents residing at the facility. Interviews were conducted throughout the facility from 11:50 am to 1:30pm. Out of all 10 residents interviewed, all residents denied ever being treated in a rough manner. Staff interviewed also denied treating residents roughly or ever seeing other staff members treat residents roughly.
Based on staff and resident interviews, this allegation is deemed UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021

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-20210528144909

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: AMBASSADOR GARDEN	FACILITY NUMBER: 197603652
	VISIT DATE: 06/04/2021

NARRATIVE

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Allegation 2. Staff made verbal threats to resident.
LPA began a facility tour at about 11:50am. LPA was able to speak with 10 residents residing at the facility. Interviews were conducted throughout the facility from 11:50 am to 1:30pm. Out of all 10 residents interviewed, one resident (R1), did state that R1 had issues with the administrator, but R1 has never had verbal threats made in their direction. All other residents stated that they have never been treated poorly at the facility and have never felt threatened. All staff stated that they have never threatened a resident nor have they heard any other staff threatening residents. Based on information received through resident and staff interviews, this allegation is deemed UNSUBSTANTIATED.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021

LIC9099 (FAS) - (06/04)

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