197606869-5-16-2024-31-AS-NMAN-DABU97-20241023152240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606869
Report Date: 05/16/2024
Date Signed: 05/16/2024 02:51:24 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
05/07/2024 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20240507112338

FACILITY NAME:	TYCOON RESIDENTIAL		FACILITY NUMBER:	197606869
ADMINISTRATOR:	YOLANDA VILLANUEVA		FACILITY TYPE:	740
ADDRESS:	10204 GERALD AVENUE		TELEPHONE:	(818) 363-3418
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	6	CENSUS: 5	DATE:	05/16/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	YOLANDA VILLANUEVA		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Staff hit resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tihesha Smith conducted an unannounced complaint investigation visit to this facility at 11:00 am. LPA Smith met with the administrator and disclosed the purpose of the visit.

Staff hit resident

It was alleged that staff hit Resident #1 (R1) with a wet rag over the face and back of head. To investigate the allegation LPA Smith requested facility documents, conducted interviews with staff, residents, interested parties and conducted a brief facility tour from approximately 11:10 am -12:30 pm. LPA was unable to interview Resident 31 (R1) as no longer resides at the facility. LPA interviews with three (3) of three (3) staff revealed they have not hit R1 or any resident and have not witnessed any staff hitting R1 or any of the residents in care. Staff #1 (S1) and Staff #2 (S2) revealed R1 was hard to take care of due to behavioral

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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-20240507112338

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: TYCOON RESIDENTIAL	FACILITY NUMBER: 197606869
	VISIT DATE: 05/16/2024

NARRATIVE

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(Cont From 9099)

issues and R1 was going through withdrawal S1 also revealed R1 was a hospice placement and no longer resides at the facility.

Interview with two (2) of five (5) residents revealed staff have not hit them and have not witnessed staff hitting any resident. One (1) of five (5) residents revealed staff very kind and have a lot of patience when dealing with the residents. Interested party revealed visits facility weekly and has never observed staff mistreating or hitting any residents. LPA Smith review of records reveal R1 has history of substance abuse and is a burn patient with burns to the face and chest that require daily cleaning and cream to be applied.

Based on interviews and record review there is not sufficient information to verify this allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

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

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC9099 (FAS) - (06/04)

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