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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197604691
Report Date: 09/06/2022
Date Signed: 09/06/2022 12:42:29 PM

Substantiated


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
09/01/2022 and conducted by Evaluator Patrick Shanahan
COMPLAINT CONTROL NUMBER: 31-AS-20220901125225
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:
09/06/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Angela Heath/ Administrator TIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff are not following Covid-19 protocols
Staff are not safeguarding cleaning materials from residents while in care
Staff did not ensure that sharp objects are inaccessible to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patrick Shanahan arrived at the facility in response to the above mentioned allegations. LPA was greeted by the facility administrator and explained the reason for the visit.

Allegation 1. Staff are not following Covid-19 protocols
LPA arrived at the home at about 9:00 AM, to conduct an infection control annual. All staff were observed to be wearing masks and all Covid-19 protocols were being followed. The LPA brought up the allegation of this complaint to the administrator at about 11:00 AM and the administrator confirmed that last month the ombudsman had visited the facility. During that visit, the staff were observed to not be wearing masks and the protocols were not properly followed. The administrator stated that all protocols are now followed and an in-service was held for all staff as a reminder.
Based on confirmation from the administrator, this allegation is deemed to be substantiated at this time.

Continues on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022
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-20220901125225
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: 09/06/2022
NARRATIVE
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Allegation 2. Staff did not ensure that sharp objects are inaccessible to residents
The LPA was able to tour the kitchen at about 10:00 AM. All knives were observed to be locked in drawers and all chemicals were observed to be locked in the garage. The administrator confirmed that she had the keys on her person and were not observed in drawers or accessible to residents. At 11:00 AM, the administrator was asked about this allegation and confirmed that last month when the ombudsman visited the home, the keys to the sharps drawer were hanging from the drawer. The administrator stated that she had been in the kitchen and had been coming in and out. The administrator confirmed that after that visit, she has kept the keys on her and does not leave them hanging from the lock.
Based on confirmation from the administrator, this allegation is deemed substantiated.

Allegation 3. Staff are not safeguarding cleaning materials from residents while in care
The LPA was able to tour the kitchen at about 10:00 AM. LPA did not observe any chemicals on the counter, under the sink or accessible to residents in care. At about 11:00 AM, the LPA asked the administrator about this allegation and confirmed that last month during the ombudsman visit, chemicals were left accessible. The administrator stated that she was in the kitchen and was coming in and out, but she had left the kitchen unattended and the chemicals were accessible for a brief amount of time. The LPA toured the rest of the facility at about 10:00 AM and no chemicals or cleaning materials were observed in any of the common areas or in any of the restrooms.
Based on confirmation from the administrator this allegation is deemed substantiated.

Exit Interview conducted, deficiencies cited and report issued.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20220901125225
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: 09/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/06/2022
Section Cited
HSC
87309(a)
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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.
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Cleared before visit. Administrator held an in-service and were observed wearing masks during todays visit.
Administrator agrees to put in writing her hunderstanding of this regulation
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This requirement is not met as evidenced by:
Based on interviews, Administrator did not ensure cleaning solutions and sharps remain inaccessible tou residents in care.. This poses an immediate health and safety risk or personal rights to residents in care.
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Type B
09/06/2022
Section Cited
CCR
87468.1(a)(2)
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Personal Rights 87468.1(a)(2) -To be accorded safe, healthful and comfortable accommodations, furnishings and equipment
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Cleared before visit. Administrator held an inservice and was observed wearing masks during todays visit.
Administrator agrees to put in writing her hunderstanding of this regulation
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This requirement is not met as evidenced by:
Based on administrator confirmation, 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.
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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.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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