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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607040
Report Date: 08/06/2024
Date Signed: 08/06/2024 03:01:09 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.RO, 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
08/02/2024 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20240802091953
FACILITY NAME:POWELL HOUSE IVFACILITY NUMBER:
197607040
ADMINISTRATOR:LINDA HUGHESFACILITY TYPE:
735
ADDRESS:43669 E. 6TH STREETTELEPHONE:
(661) 729-2454
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: 4DATE:
08/06/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Linda HughesTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff are not feeding residents in care.
INVESTIGATION FINDINGS:
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On 08/06/2024 at 09:45 am Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegation. LPA met with Administrator Linda Hughes and explained the reason for the visit.

LPA Casillas arrived at facility and there was no answer at the door. LPA Casillas called Administrator so that they could meet LPA at facility. Administrator arrived shortly after. There were no clients present as they were all at day program and will be returning to the facility at 2:00 pm.

At 10:00 AM LPA Casillas conducted a physical plant tour with Administrator. During the investigation, record reviews were conducted from 10:30 am to 12:00 pm. LPA requested resident roster, LIC 500, Administrator Certificate and Bond Certificate. LPA requested copies of pertinent information relevant to the investigation including but not limited to, resident records, menu, and any other information pertaining to resident care. LPA conducted interviews from 1:00 pm to 3:00 pm. Continued on LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20240802091953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: POWELL HOUSE IV
FACILITY NUMBER: 197607040
VISIT DATE: 08/06/2024
NARRATIVE
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Allegation: Staff are not feeding residents in care.

It is alleged that staff are not feeding residents in care. Regarding this allegation it is reported that clients are not being fed. LPA conducted interviews with two (2) out of four (4) clients and two (2) staff members along with Administrator and checked the food supply. Information obtained through interviews with two (2) out of four (4) clients and two (2) staff member present reveal that there is sufficient food for all clients in care and that there have been no instances when the facility has not had enough food for the clients. Interviews with Client #2 (C2) and Client #3 (C3) revealed that they do not go without food and that there is always food when they want it. Client #1 (C1) declined to be interviewed. Administrator states that C1 tends to eat excessively, sometimes eating 4 sandwiches at one time, however they are working on trying to regulate his eating habits. Per Administrator groceries are purchased every Friday, however since C1’s admission to the facility they will go twice a week since C1’s eating habits have increased. It was observed there were snacks for clients and there was the required two (2) days’ worth of perishable foods and seven (7) days of nonperishable foods along with emergency food stored in the garage, furthermore a delivery of fresh food was made while LPA was in the facility. LPA reviewed weight records for clients and discovered that there is no weigh loss for any of the clients. Based on the information obtained this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of this report was given to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
LIC9099 (FAS) - (06/04)
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