197606708-3-7-2024-31-AS-MVAO-D3XQ54-20240402115119

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606708
Report Date: 03/07/2024
Date Signed: 03/07/2024 10:55:07 AM

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
03/24/2023 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20230324082642

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:	03/07/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Brhyant Lopez		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility staff was not aware of resident's whereabouts.

INVESTIGATION FINDINGS:

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On 03/07/2024 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 caregiver. The facility manager Brhyant Lopez, arrived at 10:45 am LPA explained the purpose of this visit was to deliver findings for this complaint.

The investigation consisted of the following: On 03/27/2023 LPA Spaeth conducted a 10-day visit, toured the facility, and requested documents. LPA Spaeth requested the following documents: 1) client roster, 2) staff phone numbers, 3) client’s documents, and 4) incident reports relating to the complaint. All documents were received at the time of visit. During the visit, LPA interviewed the administrator and two caregivers at 2:00 pm until 3:00 pm.

LPA interviewed three staff members on 3/27/2023 at 2:30 pm until 3:30 pm via phone. LPA Spaeth also interviewed two clients on 3/27/2023 at 4:00 pm until 4:30 pm via phone.
Cont. on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

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-20230324082642

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: 03/07/2024

NARRATIVE

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The investigation revealed the following: Regarding the allegation… Facility staff was not aware of resident’s whereabouts. It’s being alleged that a client signed out of the facility one night and never returned. The client called their social worker requesting to be transferred to another facility because they did not want to return to the facility. The social worker called the Administrator and it is alleged the Administrator stated they were not aware the client had been gone from the facility overnight. It is also alleged that the facility staff members did not let the Administrator know the client was gone.

LPA interviewed two (2) of the four (4) clients. C1 did not want to be interviewed and C4 was not available. C2 and C3 both stated that if they leave the facility overnight, they inform the Administrator in advance and properly sign out. C2 and C3 have never heard another client state they left the facility overnight, did not return and staff did not know when the other client left.

LPA interviewed three (3) of the five (5) staff members. Staff 1 (S1) and Staff 2 (S2) both stated on 3/23/2023, they witnessed C1 sign out about 10:00 am and leave the facility. S1 asked when C1 would be returning. C1 did not give an answer. S1 called C1 at 5:00 pm to determine if client would be back for dinner. C1 did not answer and did not return the call. Staff 2 (S2) stated they observed C1 leaving that morning and did not return. Staff 3 (S3) was working the afternoon shift and tried to reach C1 by phone about 6:00 pm. However, C1 did not answer. S3 stated C1 returned to the facility at 9:00 pm, was upset with staff, then left again about ten minutes later.

S3 and the Administrator followed C1 while driving. C1 went down the street to a restaurant and entered. S3 and the Administrator both confirmed they entered the restaurant to ensure C1 was safe. However, C1 was upset, would not speak to the staff member or the Administrator. C1 left and staff observed C1 running away. The Administrator called the Palmdale Police Department and the deputy reported to the location. The Administrator stated a Regional Center staff member called the next day and the Administrator gave the details of the incident and sent the incident report to the Regional Center and to CCL. The Administrator and S3 were both present the evening of 3/23/2023 when C1 left the facility and did not return.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230324082642

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: 03/07/2024

NARRATIVE

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During LPA’s 3/27/2023, LPA Spaeth received a copy of the police report dated 3/23/2023 and also received a copy of the sign in sheet confirming the date of the incident was 3/27/2023.

Based on LPA’s record review and interviews conducted, the allegation, Facility staff was not aware of resident’s whereabouts is unsubstantiated.

An exit interview was conducted, and a copy of the report was given

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC9099 (FAS) - (06/04)

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