197606973-5-10-2021-31-AS-NMAN-C4EQ7L-20210628115519

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606973
Report Date: 05/09/2021
Date Signed: 05/10/2021 07:28:11 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
03/15/2021 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20210315132555

FACILITY NAME:	FEMMS RESIDENTIAL HOMES I		FACILITY NUMBER:	197606973
ADMINISTRATOR:	FRUCTUOSA M. MORALES		FACILITY TYPE:	740
ADDRESS:	11811 PASO ROBLES STREET		TELEPHONE:	(818) 217-4081
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 4	DATE:	05/09/2021
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Flory Morales - Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Resident was hit while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegation. LPA met with administrator Flory Morales and explained the reason for the visit.

LPA conducted initial visit virtually on 03/23/2021. During the initial visit, LPA interviewed staff and administrator and obtained copy of relevant facility documents. During today's visit, LPA conducted physical plant tour at 8:25 AM. At 11:15 AM, LPA interviewed Resident #1 (R1), Resident #2 (R2) and other residents. LPA interview with R2 revealed that no one ever hit R2 and staff are respectful to R2. LPA interview with R1 also revealed that R1 did not see anyone hitting anyone, only heard it from R1's room. Staff denied hitting anyone during LPA interview. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2021

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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