197606708-2-7-2024-31-AS-TAGD-D3KSV3-20240321141205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606708
Report Date: 02/07/2024
Date Signed: 02/07/2024 06:19:02 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
07/03/2023 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20230703110452

FACILITY NAME:	PALMDALE CARE FACILITY 2		FACILITY NUMBER:	197606708
ADMINISTRATOR:	DON TURNER		FACILITY TYPE:	735
ADDRESS:	37632 DALZELL STREET		TELEPHONE:	(661) 265-7423
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93550
CAPACITY:	4	CENSUS: 4	DATE:	02/07/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Brhyant Lopez.		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff did not prevent residents from physically assaulting another resident in care
Staff physically abused resident.
Facility staff stole resident's money.
Facility withheld resident's tax document.
Facility staff put hair in resident's food.
Facility staff spit in resident's food.

INVESTIGATION FINDINGS:

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Licensing Program Analyst Melissa Spaeth (LPA) conducted an unannounced visit and was greeted by house manager. LPA Spaeth stated the purpose of the visit was to present the findings regarding the allegations listed above.

In regard to the allegation, Facility staff did not prevent residents from physically assaulting another resident in care. It was alleged that a resident taunted, attacked, and bit another resident. It was also alleged that facility staff did not prevent residents from physically assaulting one another while in care. LPA Spaeth interviewed three out of the four clients. C4 did not want to be interviewed. Client 1 (C1) stated it occurred. Client 2 (C2) stated C1 called C2 a bad name and then attacked C2. C2 defended self. C2 stated they did not bite C1. C2 stated never taunted a resident and has not taunted a resident’s mother.

LPA interviewed the Administrator and three out of the five staff members. Staff one (S1), staff two (S2) and staff three (S3) did not witness the incident. S1, S2, and S3 stated they have never witnessed C2 taunting another resident and C2 has never taunted another resident’s mother. The Administrator stated staff four (S4) witnessed the incident and tried to stop the incident but both parties would not stop the fight. S4 called the Administrator and stated C1 attacked C2 and also stated S4 called the police. The

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

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-20230703110452

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: PALMDALE CARE FACILITY 2	FACILITY NUMBER: 197606708
	VISIT DATE: 02/07/2024

NARRATIVE

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Administrator arrived at the facility when the police arrived. S4 told the Administrator that C2 never bit C1 and C2 stated did not bite C1. Since C2 and S4 both confirmed S4 tried to stop the fight and both confirmed S4 called the police for assistance, the allegation is unsubstantiated.

Regarding the allegation staff physically abused a resident, it was alleged that staff and residents have beat up a resident when the resident was sleeping. C1 confirmed this occurred. C2 and C3 stated this never occurred. C4 did not want to be interviewed. LPA interviewed S1, S2, and S3 along with the Administrator. All four denied this ever occurred. Therefore the allegation is unsubstantiated.

Regarding the allegation facility staff stole resident’s money, it was alleged that a staff member took a resident’s stimulus money. C1 stated this occurred. C2 and C3 stated this type of incident has not occurred to them. C4 refused to be interviewed. The Administrator stated was contacted by the resident’s case worker. The case worker stated the resident was under the impression they would receive stimulus money but the case worker explained that the resident did not qualify. On 1/14/2024, LPA Spaeth spoke to the case worker who confirmed the resident did not receive stimulus money. The Administrator, S1, S2, and S3 stated they have never stolen a resident’s money. Therefore the allegation is unsubstantiated.

Regarding the allegation facility withheld resident’s tax document, it was alleged that staff member took a resident’s tax stubs. C1 stated this occurred. C2 and C3 stated this incident has never occurred to them. On 1/14/2024, LPA Spaeth spoke to the resident’s case worker who confirmed the resident did not work and did not receive tax documents. The Administrator, S1, S2, and S3 stated they have never taken a resident’s tax statement. Therefore the allegation is unsubstantiated.

Regarding the allegation facility staff put hair in resident’s food, it was alleged that a staff member put hair in a residents food. C1 stated this occurred. C2 and C3 stated this incident has never occurred to them. C4 refused to be interviewed. The Administrator, S1, S2, and S3 denied this has ever happened. Therefore the allegation is unsubstantiated.

Regarding the allegation facility staff spit in resident’s food, it was alleged that a staff member spit in a residents food. C1 stated this occurred. C2 and C3 stated this type of incident has never occurred to them. The Administrator, S1, S2, and S3 denied this has ever happened. The allegation is unsubstantiated.

Exit interview conducted and a copy of the report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

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