197606270-4-8-2022-31-AS-CHAS-CDQS4S-20220422133313

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606270
Report Date: 04/08/2022
Date Signed: 04/08/2022 10:59:08 AM

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
03/11/2022 and conducted by Evaluator Tuesday Cabiness

COMPLAINT CONTROL NUMBER: 31-AS-20220311083738

FACILITY NAME:	DENOGEAN ADULT RESIDENTIAL FACILITY		FACILITY NUMBER:	197606270
ADMINISTRATOR:	RICHARD W. DENOGEAN		FACILITY TYPE:	735
ADDRESS:	10712 ARTRUDE STREET		TELEPHONE:	(818) 353-8214
CITY:	SHADOW HILLS	STATE: CA	ZIP CODE:	91040
CAPACITY:	4	CENSUS: 4	DATE:	04/08/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Eny Purwiyati		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Unqualified staff providing First Aide Training

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility to deliver the Substantiated finding of the allegation mentioned above. LPA met with staff and informed her the reason of the visit. The Administrator Richard Denogean was not available; but was contacted by staff via phone. LPA spoke to Administrator and also informed him the reason of the visit. The following was determined:

On March 11, 2022, the department received an complaint for concerning unqualified staff was providing first aide training to staff at the facility. On March 14, 2022, LPA conducted the initital visit, conducted interviews and obtained documentation pertaining to the allegation. During the visit, the Administrator reported to LPA that due to the pandemic, and not having American Red Cross personnel available to conduct the training, he elected to provide the first aid training. After further review after the initial visit, and additional information was

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022

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-20220311083738

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
	VISIT DATE: 04/08/2022

NARRATIVE

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it was determined, that the Administrator was not qualified to train staff for first aide, based on Title 22 Regulations, therefore the allegation is Substantiated, and the report that was issued on March 14, 2022 for the Unsubstantiated finding is not valid. During today's visit, April 08, 2022, LPA re-issued the corrected Substantiated finding and citation.

The report was discussed via telephone with the Administrator, who also submitted the plan of correction of first aid training certificates from a credential agency. Therefore the citation was issued, and POC was cleared during the visit. No further information is needed.

Copy of report and POC emailed to Administrator.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220311083738

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: 04/08/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/08/2022 Section Cited CCR 80075(f)	1 2 3 4 5 6 7	Health Related Services: (f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. This	1 2 3 4 5 6 7	POC cleared..Administrator submited first aide certificates for all staff from a credential agency.
	8 9 10 11 12 13 14	requirement was not met, evidenced by, based on Title 22 regulations, the Administrator did not have the proper credentials to train staff for for first aide. This is a potential health and safety risk to clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022

LIC9099 (FAS) - (06/04)

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