197603823-7-30-2020-31-AS-MVAO-BS8MWF-20200806095817

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603823
Report Date: 07/30/2020
Date Signed: 07/30/2020 01:59:15 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
04/09/2020 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20200409145308

FACILITY NAME:	NORTH LAKE VILLAS INC.		FACILITY NUMBER:	197603823
ADMINISTRATOR:	NOURIT BRAUN		FACILITY TYPE:	740
ADDRESS:	2851 N. LAKE AVE		TELEPHONE:	(626) 398-8668
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	30	CENSUS: 26	DATE:	07/30/2020
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Cindy Martinez		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff yelled at residents

INVESTIGATION FINDINGS:

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Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, Licensing Program Analyst (LPA) Tuesday Cabiness delivered the final findings of the complaint investigation telephonically with Supervisor Cindy Martinez. The following was determined:

Concerns were expressed that staff yell at residents. LPA conducted interviews with the complainant, facility staff, and resident on April 15, 2020, and on July 08, 09, 16, and 21, 2020. And based on the information, it was revealed there were no witnesses to corroborate the allegation, staff yell at residents. Therefore, LPA deemed the allegation UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2020

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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