197604691-9-29-2021-31-AS-NMAN-C7YUVB-20211020155452

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197604691
Report Date: 09/29/2021
Date Signed: 09/29/2021 02:57:35 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
09/01/2020 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20200901145741

FACILITY NAME:	ANGIE'S HOME CARE, INC.		FACILITY NUMBER:	197604691
ADMINISTRATOR:	HEATH, ANGELA		FACILITY TYPE:	740
ADDRESS:	16456 LOS ALIMOS ST		TELEPHONE:	(818) 366-7906
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	4	CENSUS: 4	DATE:	09/29/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Angie Heath - Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Licensee handles resident in a rough manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with administrator Angela Heath and explained the reason for the visit.

LPA conducted physical plant tour at 11:35 AM, requested and reviewed facility records at 11:55 AM and interviewed staff and residents between 11:55 AM to 1:00 PM. LPA's interview with residents between 11:55 AM to 1:00 PM, revealed that they were not handled roughly by any staff and did not witness any staff mis treating, disrespecting or roughly handling any resident. Administrator and staff denied they handled they roughly handled Resident #1 (R1) or any resident at the facility during LPA's interview between 11:55 AM to 1:00 PM. LPA attempted to call the R1's power of attorney (POA) multiple times to no avail. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

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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