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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197604475
Report Date: 08/02/2024
Date Signed: 08/02/2024 03:44:33 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
08/11/2023 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20230811102632
FACILITY NAME:POWELL HOUSE, INC IIFACILITY NUMBER:
197604475
ADMINISTRATOR:LINDA HUGHESFACILITY TYPE:
735
ADDRESS:1745 LIGHTCAPTELEPHONE:
(661) 945-0375
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: 4DATE:
08/02/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Linda HughesTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Unlawful Eviction
INVESTIGATION FINDINGS:
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On 8/02/2024 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth was met by Administrator. LPA explained the purpose of this visit was to deliver the findings for this complaint.

LPA Spaeth toured the facility at 10:15 am until 10:30 am and did not observe any health or safety issues.
The investigation consisted of the following: On 8/21/2023 LPA Spaeth initiated a complaint investigation. LPA reviewed resident records and obtained copies of the documentation.

The investigation revealed the following: Regarding the allegation, Unlawful Eviction; it’s being alleged the facility Administrator (A1) refused to pick up a client (C1) from the hospital due to C1’s aggressive behavior toward staff.

Cont. on 9099C

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 31-AS-20230811102632
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: POWELL HOUSE, INC II
FACILITY NUMBER: 197604475
VISIT DATE: 08/02/2024
NARRATIVE
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The hospital staff was interviewed on 7/30/2024 at 2:00 pm who stated they called the Administrator on 8/09/2023, informed the Administrator that C1 was being released from the hospital and was ready to be picked up. The Administrator stated they refused to pick up C1 due to C1’s aggressive behavior toward staff.

LPA Spaeth interviewed the Administrator on 8/21/2023 at 10:00 am. The Administrator confirmed C1 had been sexually aggressive toward staff, physically aggressive toward staff and clients. The staff and Administrator were not comfortable providing care to C1. The Administrator (A1) stated they would not pick up C1 from the hospital due to C1’s sexual aggression toward the staff and physical aggression toward the staff and clients. The Administrator confirmed they had immediately contacted the North Los Angeles Regional Center, spoke to the social worker at the hospital and forwarded the incident report to CCL regarding the aggressive behavior of the client. However, no help or guidance was provided to the Administrator. The Administrator confirmed C1 has moved into another facility.

LPA spoke to the Licensee from the other facility on 7/30/2024 at 11:00 am who confirmed that Licensee picked up C1 from the hospital on 8/15/2023. The licensee confirmed C1 moved into the facility on 8/15/2023 and also confirmed C1 is still a client of the facility. Based upon LPA’s interviews of the hospital staff, A1 and A2, the allegation is substantiated. Per CA Code of Regulations, Title 22, the following deficiency is issued (See 9099-D).

Exit interview conducted, appeal rights discussed, and a copy of the report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 31-AS-20230811102632
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: POWELL HOUSE, INC II
FACILITY NUMBER: 197604475
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2024
Section Cited
CCR
85068.5(a)
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85068.5 Eviction Procedures (a) The licensee shall be permitted to evict a client by serving the client with a 30-day written notice….This is evidenced by:
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LPA Spaeth reviewed the Title 22 Regulations 85068.5 with the Administrator.
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Based upon interviews of the hospital staff, the Administrator and the Licensee of the other facility, the facility did not pick up C1 from the hospital which poses immediate personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3