197604475-5-22-2023-31-AS-NGID-CT6P48-20230626105844

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197604475
Report Date: 05/22/2023
Date Signed: 05/22/2023 12:05:54 PM

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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/22/2023 and conducted by Evaluator Shira Stamps

COMPLAINT CONTROL NUMBER: 31-AS-20230322143202

FACILITY NAME:	POWELL HOUSE, INC II		FACILITY NUMBER:	197604475
ADMINISTRATOR:	LINDA HUGHES		FACILITY TYPE:	735
ADDRESS:	1745 LIGHTCAP		TELEPHONE:	(661) 945-0375
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	4	CENSUS: 4	DATE:	05/22/2023
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	LoWana Carr, Caregiver		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff do not allow resident to walk in the backyard
Staff refused to give the resident vegetables

INVESTIGATION FINDINGS:

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At 10:05 am Licensing Program Analyst (LPA) Shira Stamps arrived at the facility mentioned above for a subsequent complaint visit. Entrance and exit interview conducted with the Administrator over the phone. The Adminstrator stated Caregiver LoWana Carr could sign the report.

Allegation: Staff do not allow resident to walk in backyard

It is alleged that staff do not allow client #1 (C1) to walk in the backyard. Interviews with four (4) out of four (4) staff members indicated that all clients could go in the backyard if staff is present, due to supervision needs. Based on document review of all client’s physician reports it was found that three (3) out of four (4) clients are unable to leave the facility without staff supervision. It was also indicated by staff members that clients cannot go out in the backyard in severe weather conditions, such as extreme heat or cold. One (1) out of four (4) clients indicated that it is forbidden to go in the backyard until the fence gets fixed. LPA conducted a tour of the backyard and found the perimeter fence not to be broken. CONTINUED...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

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 31-AS-20230322143202

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: POWELL HOUSE, INC II	FACILITY NUMBER: 197604475
	VISIT DATE: 05/22/2023

NARRATIVE

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LPA interviewed a staff member who indicated the left side of the fence was partially replaced in March, and the back part of the perimeter fence was replaced in May. Staff also indicated while the handyman was repairing the fence the clients were still able to go in the backyard with staff supervision. Three (3) out of four (4) clients indicated that although staff allow clients in the backyard, there are restrictions that requires clients to ask for permission. LPA conducted a tour of the backyard and observed there to be a sitting area for clients. The umbrella is stored in the locked office due to heavy winds in the area. LPA observed there to be sharp old wood fence pieces stored on the right side of house with nails sticking out of the wooden boards. Based on interviews staff do allow clients in the backyard with staff supervision, unless there are severe weather conditions, therefore the allegation, “staff do not allow resident to walk in the backyard,” is deemed UNSUBSTANTIATED.

Allegation: Staff refused to give resident vegetable

It is alleged that C1 wanted to eat a salad instead of chips, and staff refused to give C1 the vegetables. Interviews with four (4) out of four (4) clients indicated that staff give vegetables with every meal, and the client’s indicated staff have never refused to give clients vegetables. Interviews with three (3) out of three (3) staff members indicated vegetables are given with every meal. On 5/11/23, LPA observed the refrigerator to contain vegetables and fruit. Therefore, based on interviews the allegation, “Staff refused to give resident vegetable,” is deemed UNSUBSTANTIATED.

Exit interview conducted. Report Delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

LIC9099 (FAS) - (06/04)

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