197606348-1-18-2024-31-AS-NGID-CZUU5V-20240126141719

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606348
Report Date: 01/18/2024
Date Signed: 01/18/2024 11:22:36 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
12/21/2023 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20231221125337

FACILITY NAME:	COMMUNITY INTEGRATION ADC		FACILITY NUMBER:	197606348
ADMINISTRATOR:	PETER MEDVEDEV		FACILITY TYPE:	775
ADDRESS:	10100 BALBOA BL.		TELEPHONE:	(818) 772-1155
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	120	CENSUS: 27	DATE:	01/18/2024
		UNANNOUNCED	TIME BEGAN:	09:12 AM
MET WITH:	Bob Erio		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff forced a client to sit in a chair for a long period of time.
Staff scolded a resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit to deliver the finding for the above stated allegation. LPA met with the COO and explained the reason for the visit. Entrance interview.

Allegation: Staff scolded a resident in care

On 01-02-2024 License Program Analyst (LPA) Leslie Ngo-Castaneda initiated the visit. Today LPA conducted a tour of the center 9:30AM. During the facility tour LPA Interviewed nine (9) individual staff members and ten (10) attendees. LPA conducted record review of staff and attendees at 9:50 AM. Witness was interviewed 1-5-2024 at 12:14 PM and 1-09-2024 at 4:03 PM. Complaint was also alleged that the staff scolded the resident while in care for digging through the trash for papers, stuffing the papers under the doors of the facility and stuffing their pockets full of papers to take home.
Continue to LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

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 5

Control Number 31-AS-20231221125337

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMMUNITY INTEGRATION ADC	FACILITY NUMBER: 197606348
	VISIT DATE: 01/18/2024

NARRATIVE

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Interview with family and attendee confirmed that the allegation had happened and that the staff was reprimanded for their action. The center sent an apology letter to the victim family regarding how staff treated the attendee. LPA was able to obtain a copy of the letter and a write-up for their actions. The center had offered to re-train the staff in proper communication skills.

Allegation: Staff forced a client to sit in a chair for a long period of time.

Upon further investigation it was also alleged that staff forced a client to sit in a chair for a long period of time. Witness interview and review of records it was discovered that the victim was scared and vulnerable from the staff from scolding for going through the trash for papers.

Staff did not redirect the attendee to do other activities offered in the center. The victim would end up sitting on the chair for a long period of time after being scolded for digging in the trash for paper and food due to their behaviors.

Therefore, based on interviews, observation, and document review, there is a sufficient information to support the allegation. Therefore, this allegation is deemed substantiated.

Deficiencies were issued and recorded on LIC9099D.

Exit interview conducted. Report signed and delivered. Appeal rights delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20231221125337

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMMUNITY INTEGRATION ADC	FACILITY NUMBER: 197606348
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/18/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/18/2024 Section Cited CCR 82072(a)(1)	1 2 3 4 5 6 7	Personal Rights (a) Each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons.	1 2 3 4 5 6 7	Staff has offered to re-train staff for re-directing attendees in the program. COO has given LPA training certificate on 1.18.2024.
	8 9 10 11 12 13 14		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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
12/21/2023 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20231221125337

FACILITY NAME:	COMMUNITY INTEGRATION ADC		FACILITY NUMBER:	197606348
ADMINISTRATOR:	PETER MEDVEDEV		FACILITY TYPE:	775
ADDRESS:	10100 BALBOA BL.		TELEPHONE:	(818) 772-1155
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	120	CENSUS: 27	DATE:	01/18/2024
		UNANNOUNCED	TIME BEGAN:	09:12 AM
MET WITH:	Bob Erio		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Client is being sexually abused while in care.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 31-AS-20231221125337

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMMUNITY INTEGRATION ADC	FACILITY NUMBER: 197606348
	VISIT DATE: 01/18/2024

NARRATIVE

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Based on interviews, attendees and staff did not observe any evidence of sexual abuse to client #1/alleged victim (C1) or any other clients in care. Interviews with 10 out of 27 clients that were able to communicate, did not observed or experienced any acts of sexual abuse.

LPA interviewed Staff #1/alleged perpetrator(S1) who stated denied the allegation. Client #1 was interviewed and denied the allegation of sexual abuse. During the course of the investigation, a witness clarified that it was not physical but more psychological abuse.

Based on the information gathered the investigation, the allegation is deemed unsubstantiated at this time. There is no one to corroborate that C1 or any resident was sexually abused while in care.

Copy of this report issued.

Exit interview conducted.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC9099 (FAS) - (06/04)

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