<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197604691
Report Date: 02/09/2022
Date Signed: 02/09/2022 12:14:22 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
02/07/2022 and conducted by Evaluator Joscelyn Martinez
COMPLAINT CONTROL NUMBER: 31-AS-20220207122630
FACILITY NAME:ANGIE'S HOME CARE, INC.FACILITY NUMBER:
197604691
ADMINISTRATOR:HEATH, ANGELAFACILITY TYPE:
740
ADDRESS:16456 LOS ALIMOS STTELEPHONE:
(818) 366-7906
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:4CENSUS: 4DATE:
02/09/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Angela Heath TIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not following Covid-19 protocols
Staff are not safeguarding cleaning materials from residents while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 10:00 A.M Licensing Program Analysts (LPAs) Joscelyn Martinez and Melissa Ruiz made an unannounced visit to conduct a complaint investigation. Upon arrival, LPAs were greeted by the Administrator.

Allegation #1 Staff are not following Covid-19 protocols.

Upon entrance, LPAs observed staff and Administrator not wearing a surgical mask. LPAs had to remind staff and Administrator to wear a mask at all times. Additionally, LPAs were not properly screened for infection control protocols upon arrival. Based on LPA’s observation this allegation is substantiated at this time.

Allegation #2 Staff are not safeguarding cleaning materials from residents while in care.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
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-20220207122630
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: ANGIE'S HOME CARE, INC.
FACILITY NUMBER: 197604691
VISIT DATE: 02/09/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
At 10:05 LPAs conducted a facility tour. Upon touring the kitchen, LPAs observed Clorox cleaning solutions under the sink that were accessible to residents in care. At 10:15 LPAs interviewed the Administrator and the Administrator stated that about a month ago, Ombudsman had conducted a visit and had saw a cleaning solution on the kitchen table, which was accessible to residents. Based on LPA’s observation and interview conducted this allegation is substantiated at this time. During the end of the facility tour, LPAs also observed sharps in a unlock drawer which were accessible to residents. Administrator stated she always carries the keys, however LPAs reminder the Administrator that knives always have to be locked. Since Administrator was not available to sign the report, Administrator designated staff to sign.

Deficiencies were issued per CA code of Regulations Title 22. See 9099D's included with this report. Appeal rights issued. Report delivered. Exit interview conducted.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20220207122630
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: ANGIE'S HOME CARE, INC.
FACILITY NUMBER: 197604691
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/11/2022
Section Cited
CCR
87468.1(a)(2)
1
2
3
4
5
6
7
Personal Rights 87468.1(a)(2) -To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

1
2
3
4
5
6
7
Administrator agreed to train all staff on Mitigation Plan and Infection Control which includes screening and usage of masks. Staff sign-in sheet and training materials shall be e-mailed to LPA by POC due date.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
Based on LPAs observations, staff and Administrator were not wearing surgical masks. Administrator did not screen for infection control. This poses an immediate health and safety risk or personal rights to residents in care.
8
9
10
11
12
13
14
Type A
02/11/2022
Section Cited
CCR
87309(a)
1
2
3
4
5
6
7
Storage Space 87309(a)- Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
This requirement is not met as evidenced by:

Based on observations and interview, Administrator did not ensure cleaning solutions and sharps remain inaccessible tou residents in care. LPAs observed a cleaning agent and shaprs accessible. This poses an immediate health and safety risk or personal rights to residents in care.
8
9
10
11
12
13
14
Administrator agreed to train all staff on ensuring cleaning solutions and shaprs remain inaccessible to residents at all times. Staff sign-in sheet and training materials shall be e-mailed to LPA by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3