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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606660
Report Date: 06/20/2024
Date Signed: 06/20/2024 02:35:51 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
04/03/2023 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20230403163203
FACILITY NAME:JOY HOME CENTERFACILITY NUMBER:
197606660
ADMINISTRATOR:ZINAIDA AKSELRUDFACILITY TYPE:
735
ADDRESS:8042 MCNULTY AVENUETELEPHONE:
(818) 571-2247
CITY:CANOGA PARKSTATE: CAZIP CODE:
91306
CAPACITY:4CENSUS: 4DATE:
06/20/2024
UNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Herbert AmanyaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Resident was physically assaulted by staff
INVESTIGATION FINDINGS:
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On 6/20/2024 Licensing Program Analyst (LPA), Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth was met by the Licensee. LPA explained the purpose of this visit was to present the findings.

The investigation consisted of the following: On 4/04/2023, LPA Spaeth initiated a complaint investigation. LPA reviewed client files and interviewed the Administrator and the Facility Manager. LPA Spaeth received copies of the client’s documents.

Regarding the allegation: Resident was physically assaulted by staff. It’s being alleged that a client (C1) was physically assaulted by a staff member. An incident occurred in which a one-on-one care provider

Continued 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
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-20230403163203
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: JOY HOME CENTER
FACILITY NUMBER: 197606660
VISIT DATE: 06/20/2024
NARRATIVE
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was assisting C1 with their personal needs. C1 became upset, grabbed the one-on-one care provider’s hands and a facility staff member intervened. The facility staff member allegedly pushed C1 to the wall, led C1 to the living room couch, and held down C1’s hands on the couch.

The reporting party provided the name of the staff member. LPA Spaeth interviewed the Administrator and Facility Manager on 4/04/23 at 11:00 am and interviewed four staff members (S1, S2, S3, S4) out of the eleven (11) staff members on 6/12/2024 via phone call who unanimously stated there was no caregiver by that name.

S1 - S4 stated that they have never physically assaulted a client, have never witnessed another staff member assault a client, and the clients have never stated a staff member has assaulted them. S1 – S4 all stated when a client becomes aggressive, they verbally try to redirect the client in a calm voice but never use force. The four staff members also stated they have never held down a client when the client exhibits disruptive behaviors. S1 -S4 all stated they have learned what verbal strategies work for each client and will positively reinforce those verbal strategies when a client is aggressive. S1 – S4 have confirmed they have received the CPI training and, also stated they immediately report any aggressive behaviors to the Administrator and to the Facility Manager.

The Administrator and Facility Manager confirmed all staff members have received the required training, have been instructed to report aggressive behaviors to the Administrator and the Facility Manager. The Administrator and the Facility Manager stated staff have not stated they witnessed another staff member holding down a client. The facility clients have never reported to them that a staff member has assaulted them.

LPA Spaeth attempted to interview C1 but C1 refused. During LPA Spaeth’s 4/04/2023 visit, three (3) out of the four (4) residents were participating in community activities and were unavailable for an interview.

LPA received copies of client’s records which reveal C1 does have disruptive behaviors. LPA reviewed two incident reports which state C1 was physically aggressive toward facility staff. At 11:45 am, LPA Spaeth reviewed the CPI Foundation Participants Guide and observed Unit 8 Physical Interventions-Disengagement Skills section provides specific training on how to divert specific behaviors without physically holding down the client.

Based upon staff interviews and review of the client’s records, the allegation, resident was physically assaulted by staff is unsubstantiated. Exit interview conducted and a copy of the signed report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC9099 (FAS) - (06/04)
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