197603675-10-24-2022-29-AS-KHEN-CKY2R3-20221107163652

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603675
Report Date: 09/16/2022
Date Signed: 10/24/2022 11:33:52 AM

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
10/01/2020 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 29-AS-20201001122338

FACILITY NAME:	GILMAR MANOR		FACILITY NUMBER:	197603675
ADMINISTRATOR:	VLADIMIR CHERTOK		FACILITY TYPE:	735
ADDRESS:	15152 VICTORY BLVD.		TELEPHONE:	(818) 989-2651
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91411
CAPACITY:	78	CENSUS: 72	DATE:	09/16/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Gabriela Chavez		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not safeguard resident's money.
Staff do not allow resident to speak with family members.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent complaint visit to deliver findings for the above allegations. During today’s visit, LPA Ascencio met with Office Manager Johana Chavez at 09:50 a.m. and explained the reason for the visit. LPA and Office Manager Chavez toured the facility inside and out at 9:53 a.m. Administrator Gabriela Chavez arrived at the facility at 12:00 p.m. On 10/22/2022, this report was amended to conduct additonal clients interviews add additional information, which does not change the original findings of the unsubstatiated report being issued referenced on 09/16/22.

On 10/01/2020, the Department received a complaint regarding allegation of staff not safeguarding resident’s money. On 10/09/2020, LPA Eva Miller initiated the initial complaint. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) a FaceTime visit with Licensee Vladimir Chertok. During LPA Miller’s visit, staff interview was conducted, and pertinent documents were obtained.

Continued on LIC 9099 - C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

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-20201001122338

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: GILMAR MANOR	FACILITY NUMBER: 197603675
	VISIT DATE: 09/16/2022

NARRATIVE

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On 09/09/2022, starting at 11:15 a.m., LPA Ascencio conducted four (4) staff interviews. Staff interviews revealed that once clients pay their rent for the month, the remainder of monies is to be held at the facility, or given to the clients. We keep tract in the Personal and Incidental (P&I) Binder. The clients can then request their money with the Admin who will update the P&I Binder. The majority of the clients, their Social Security Income (SSI) comes to the building. Admin uses the SSI monies to pay the clients rent. On 09/09/2022 starting at 11:45 a.m. and on 10/22/2022 starting at 10:27 a.m., LPA Ascencio conducted interviews with eleven (11) clients. Client interviews revealed that they haven’t had any issue with the facility not providing them money when requested. Further interviews with clients also revealed that the facility gets paid for their monthly rent, and whatever is left over, gets written in the books. When we want money, we pull what we need, update the book and sign to confirm what we took and what is left over. Additional interviews also revealed that clients SSI money arrive to Admin Gabby. Admin Gaby takes the rent money from the SSi check, and gives the left over to the clients. Left over monies range from $128.00 - $250.00. Later that day, starting at 12:15 p.m., LPA Ascencio reviewed seven (7) out of 72 clients P&I files and noted all 7 clients having current records. Based on record review, and interviews, the allegation, staff did not safeguard resident’s money is deemed UNSUBSTANTIATED at this time.

Regarding the allegation, staff do not allow resident to speak with family members. On 10/09/2020, and 09/09/2022, starting at around 11:15 a.m., LPA Ascencio conducted interviews with 4 staff members. Interviews with staff revealed that when a client receives a phone call, the reception area would use the Public Address (PA) system to page the client. The client will then come to the reception area and take their call. Further staff interviews also revealed that some clients receive calls but chose not to take them. Interviews with six (6) clients, starting at 11:45 a.m., revealed that the phone in the front desk can be used by anyone at any time. The front desk will use the call system to alert us of a phone call. Further interviews revealed that the clients have privacy when they received or make phone calls. Additionally, client interviews also revealed that they have never been denied access to make phone calls. Based on interviews, the allegation, staff do not allow residents to speak with family members is deemed UNSUBSTANTIATED at this time.

Exit interview conducted and a copy of the report provided to admin via email.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

LIC9099 (FAS) - (06/04)

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