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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606270
Report Date: 11/03/2021
Date Signed: 11/03/2021 04:03:56 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
09/16/2020 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20200916160958
FACILITY NAME:DENOGEAN ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
197606270
ADMINISTRATOR:RICHARD W. DENOGEANFACILITY TYPE:
735
ADDRESS:10712 ARTRUDE STREETTELEPHONE:
(818) 353-8214
CITY:SHADOW HILLSSTATE: CAZIP CODE:
91040
CAPACITY:4CENSUS: DATE:
11/03/2021
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff illegally evicted resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst Abeye Duguma conducted an unannounced visit on this day in order to deliver investigation findings. LPA arrived to the facility at 2:35pm. A tour of the physical plant was conducted at 3:00pm. No health and safety hazard noted. It was alleged that upon discharge from the hospital, the staff refused to take resident #1 (R1) back to the facility. An investigation of this complaint was conducted by the LPA Alex Pitz. As part of this investigation, LPA interviewed the complainant and reviewed associated documents on 9/17/20; interviewed the North Los Angeles County Regional Center (NLACRC) caseworker for resident 1 (R1) on 9/17/20 and 9/21/20; interviewed the administrator and conducted a virtual visit on 9/21/20. LPA reviewed documents submitted by the administrator and received in the Woodland Hills Regional Office (WHRO) on 9/24/20. The allegation, that “Staff illegally evicted resident,” has been substantiated based on the records reviewed and interviews conducted. The administrator confirmed during the 9/21/20 interview, and subsequently in writing on 9/22/20, that R1 was hospitalized for a psychiatric evaluation after unexpectedly physically assaulting a staff member, was medically cleared by the hospital, but not allowed back to the facility due to safety concerns for the other residents and staff.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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 2
Control Number 31-AS-20200916160958
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: DENOGEAN ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 197606270
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2021
Section Cited
CCR
80068.5(b)
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80068.5(b) The licensee shall obtain prior written approval from the Department to evict the client upon three (3) days written notice to quit and upon a finding of good cause. This requirement is not met as evidenced by: Based on the interviews conducted and records reviewed, the facility did not request approval from the department
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Administrator will attend a training on eviction procedures from an approved vendor and submit a signed statement of understanding and intent to abide by the cited regulation.
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in writing prior to evicting. Resident 1, which poses an immediate risk to the health, safety or personal rights of 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.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC9099 (FAS) - (06/04)
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