197607183-9-9-2022-31-AS-NGID-CJHPAJ-20220922110846

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607183
Report Date: 09/09/2022
Date Signed: 09/09/2022 09:27:35 AM

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
07/15/2022 and conducted by Evaluator Shira Stamps

COMPLAINT CONTROL NUMBER: 31-AS-20220715110614

FACILITY NAME:	AVENUE "H" GUEST HOME, INC.		FACILITY NUMBER:	197607183
ADMINISTRATOR:	JOEL FLETCHER		FACILITY TYPE:	735
ADDRESS:	3640 AVENUE H-13		TELEPHONE:	(661) 916-7507
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	4	CENSUS: 4	DATE:	09/09/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Belinda Hicks,Co- Administrator		TIME COMPLETED:	09:35 AM

ALLEGATION(S):

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Uncleared adult on premises harassing resident
Staff do not ensure a safe and healthy environment by hitting resident in care
Staff do not ensure a safe and healthy environment by yelling at resident in care
Staff do not ensure a safe and healthy environment by speaking inappropriately to a resident
Staff do not ensure a safe and healthy environment by slamming door in residents face

INVESTIGATION FINDINGS:

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At 9:00 am, Licensing Program Analyst (LPA) Shira Stamps conducted a subsequent complaint visit. Entrance interview conducted with the Administrator.

LPA conducted a physical plant tour. On 7/19/22 an initial investigation was conducted, and LPA conducted interviews with staff, clients, and requested relevant documents. On 9/9/22 additional interviews were conducted.

Allegation: Uncleared adult on premises harassing resident

It is alleged that there is an uncleared male adult that harasses the clients at the facility and will knock on their bedroom doors and whisper their names. Staff interviews indicated there are no male staff at the facility, and there are no male visitors that come to the facility. Staff did indicate that S1’s husband will pick up S1 at the facility, but that he waits outside and has never come into the facility. LPA reviewed the Guardian system and verified that S1’s husband is fingerprint cleared for another facility. CONTINUED...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022

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-20220715110614

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: AVENUE "H" GUEST HOME, INC.	FACILITY NUMBER: 197607183
	VISIT DATE: 09/09/2022

NARRATIVE

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LPA interviewed the husband who indicated he has never worked in the home and has never been inside the home. He indicated he waits outside to pick up S1. Interviews with clients indicated there are no male adults that visit or come into the facility. Therefore, based on interviews and document reviews, the allegation, “Uncleared adult on premises harassing resident,” is deemed unsubstantiated.

Allegations: Staff do not ensure a safe and healthy environment by hitting resident in care
Staff do not ensure a safe and healthy environment by yelling at resident in care
Staff do not ensure a safe and healthy environment by speaking inappropriately to a resident

It is also alleged that for the last two (2) weeks S1 and S2 have been hitting, yelling, and calling C1 mental and telling C1 that C1 must leave the home. Interviews with clients indicated staff do not hit, yell, or call client’s names. Client interviews indicated clients like living in the home and staff treat them very well. Interviews with staff indicated they have never hit or yelled at a client or spoken inappropriately to clients. Staff interviews indicated during the incident that occurred on Friday 7/15/22, C1 was yelling and screaming, and staff raised their voices when speaking to C1 so that C1 could hear staff. Staff indicated they were trying to calm C1 down and were asking C1 what was wrong. Interviews with clients indicated staff was helpful during the incident. Therefore, based on interviews, the above allegations are deemed unsubstantiated.

Allegation: Staff do not ensure a safe and healthy environment by slamming door in residents face

It is alleged that S1 and S2 have slammed doors in C1’s face. Staff interviews indicated that staff have never slammed a door in a client’s face and have never seen any other staff slam doors in client’s faces. Staff interviews indicated C1 and C4 are the clients that slam doors in the facility. Client interviews indicated staff have never slammed doors in clients faces. Therefore, based on interviews, the allegation, “Staff do not ensure a safe and healthy environment by slamming door in residents face,” is deemed unsubstantiated.

Exit interviews conducted, appeal rights and copy of report delivered to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022

LIC9099 (FAS) - (06/04)

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