197606909-10-29-2019-31-AS-JNAA-BHMPTW-20191105103637

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606909
Report Date: 10/29/2019
Date Signed: 10/29/2019 11:36:49 AM

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
06/13/2019 and conducted by Evaluator Alexander Pitz

COMPLAINT CONTROL NUMBER: 31-AS-20190613111558

FACILITY NAME:	PEOPLE CREATING SUCCESS, INC. PCS-PARTHENIA		FACILITY NUMBER:	197606909
ADMINISTRATOR:	ANDREA DEVERS		FACILITY TYPE:	735
ADDRESS:	22005 PARTHENIA AVENUE		TELEPHONE:	(818) 715-0977
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91304
CAPACITY:	5	CENSUS: 4	DATE:	10/29/2019
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Brandy Maynard		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff hit resident.
Facility staff prohibited resident access to the restroom

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Pitz conducted an unannounced visit on this day in response to the above allegations. As part of this investigation LPA interviewed the alleged victim, the facility administrator, regional manager, and 8 staff members. LPA also reviewed records from the facility and North Los Angeles Regional Center, and requested records from the Topanga Community Police Department.
Allegation #1, that “Facility staff hit resident,” has been unsubstantiated based on records review and interviews conducted. The alleged perpetrator denied the allegation, there was no eye witness to the alleged abuse, the responding police officers did not take a report, and the alleged victim’s credibility is uncertain.
Allegation #2, that “Facility staff prohibited resident access to the restroom,” has been unsubstantiated based on records review and interviews conducted. The alleged perpetrator denied the allegation, there was no eye witness to the alleged abuse, the responding police officers did not take a report, and the alleged victim’s credibility is uncertain.
Report reviewed, signed and delivered. Exit interview conducted, no deficiencies cited.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jill Nakata	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Alexander Pitz	TELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

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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