197606617-4-11-2022-31-AS-NGID-CDHS97-20220415134013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606617
Report Date: 04/11/2022
Date Signed: 04/11/2022 12:56:36 PM

Unsubstantiated

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
04/04/2022 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20220404151148

FACILITY NAME:	SAILS NEW CASTLE		FACILITY NUMBER:	197606617
ADMINISTRATOR:	AYOBAMI TEMILOLUWA		FACILITY TYPE:	735
ADDRESS:	11505 NEW CASTLE AVE		TELEPHONE:	(818) 224-7364
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	4	CENSUS: 3	DATE:	04/11/2022
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Daniela Mosquera		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Resident sustained multiple injuries while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in response to the above mentioned allegation. LPA explained the reason for the visit. LPA had his temperature taken and COVID-19 questions were asked before entering the home.
Regarding this allegation, the LPA was able to interview staff and gather and review pertinent documentation regarding the resident in question (R1). A review of the residents most recent Annual/Quarterly Progress Evaluation Report, conducted on 07/09/21, indicated that the resident in question (R1) has a history of self injurious behaviors. The report also indicated that there is no set 1 on 1 staff needed for R1 and R1 can use the restroom and can sleep on their own.
A review of injuries submitted as Incident Reports for 2022 were also reviewed. On 2/14/22, it was reported that R1 was observed to have a head laceration which required stitches. Staff present at the time of the incidents were interviewed and confirmed that the resident was observed coming out of the restroom with the head injury. The wound was treated and R1 was taken to the hospital.
Cont. on LIC-9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

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

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220404151148

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: SAILS NEW CASTLE	FACILITY NUMBER: 197606617
	VISIT DATE: 04/11/2022

NARRATIVE

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There were 2 staff present at this time and the resident was treated immediately.

On 4/1/22, it was reported that R1 had tripped and and sustained a cut on R1's private area. Staff present at the time of that injury were interviewed about 11:30 AM over the telephone. Staff indicated that all residents were sleeping and that the night staff was just finishing mopping the floor, when R1 woke up and ran to the bathroom and tripped on a bucket. R1 was wet and staff assisted the resident in the bathroom to dry R1. While drying R1, staff observed a small cut on R1's private area. Staff indicated that R1 became agitated with the injury and began pulling at the wound and creating more damage. Staff stated that this agitation continued at the hospital, where hospital staff were needed to to assist in restraining the resident so that the wound could be treated.

Based on a review of R1's pertinent documentation and interviews conducted with staff, the facility has remained sufficiently staffed and injuries that have occurred have been self inflicted, therefore this allegation is deemed unsubstantiated at this time.

Exit interview conducted and report issued.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

LIC9099 (FAS) - (06/04)

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