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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607701
Report Date: 10/23/2023
Date Signed: 10/23/2023 04:29:50 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.ASC, 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
10/19/2023 and conducted by Evaluator Antonia Alvizar
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20231019164557
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA DEBRA HOMEFACILITY NUMBER:
197607701
ADMINISTRATOR:VEGA TAPIA, DANNYFACILITY TYPE:
735
ADDRESS:10101 DEBRA AVETELEPHONE:
(818) 894-6938
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:4CENSUS: 4DATE:
10/23/2023
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff made inappropriate comments to resident while in care
INVESTIGATION FINDINGS:
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At 11:15 a.m. Licensing Program Analysts (LPA) Antonia Alvizar arrived to the facility to conduct an initial complaint visit. Upon arrival, LPA was greeted by staff Louis Mendoza and LPA then met with the Director, Danny Tapia and Administrator, Barbara Pacheco. LPA explained the purpose of the visit. At 11:56 p.m. staff Christopher Castro and LPA conducted a physical plant tour of facility.

Staff made inappropriate comments to resident while in care.

It is alleged that in the past, staff have made inappropriate comments to Client (C1) they need incontinence care to identifying that C1 is dirty, or announcing that needs to be changed.
Based on interviews, it was revealed that staff do not make inappropriate comments to C1 and that is consider verbal abuse. Staff stated they receive training on Understanding and Recognizing Abuse. LPA Alvizar reviewed training record and verified the information provided by staff was correct. An interview with staff (S1) indicated that has never heard other staff saying inappropriate words to C1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
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-20231019164557
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA DEBRA HOME
FACILITY NUMBER: 197607701
VISIT DATE: 10/23/2023
NARRATIVE
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Based on interviews obtained and record review, there was not enough evidence to support the allegation resident/client sustained injuries in care, so the allegation is deemed unsubstantiated.

No deficiencies issued.
Report signed and delivered to the Administrator, Pacheco.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2