197607821-3-27-2024-31-AS-MVAO-D49NK7-20240412103127

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607821
Report Date: 03/27/2024
Date Signed: 03/27/2024 12:20:31 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
10/06/2022 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20221006193944

FACILITY NAME:	ZION RESIDENTIAL CARE		FACILITY NUMBER:	197607821
ADMINISTRATOR:	ARTHUR AGUILAR		FACILITY TYPE:	740
ADDRESS:	16654 SAN FERNANDO MISSION BLV		TELEPHONE:	(818) 620-2202
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 3	DATE:	03/27/2024
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Jenneth Aguilar		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are not properly trained.
Facility staff are not providing adequate supervision.

INVESTIGATION FINDINGS:

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

On 03/27/2024 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced subsequent complaint visit. Upon arrival LPA met with staff#2 (S2) and staff#3 (S3). S2 contacted the Administrator, Jenneth Aguilar by telephone and LPA explained the purpose of the visit. Janneth met LPA shortly after. Entrance interview conducted.

At approximately 9:40 a.m. Licensing Program Analyst (LPA) Evelin Rios, conducted a physical plant tour of the facility to ensure the health and safety of the residents in care and interviewed the administrator. LPA did not observe any issues or concerns. From approximately 10:00 a.m. to 10:30 a.m. LPA conducted interviews with two (2) out of three (3) residents in care. One (1) out of the three (3) residents was sleeping. LPA also conducted interviews with the (2) staff present. At approximately 11:00 a.m. LPA reviewed and obtained copies of S1 and S2 training records, resident roster and LIC500.
(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

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-20221006193944

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ZION RESIDENTIAL CARE	FACILITY NUMBER: 197607821
	VISIT DATE: 03/27/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Continued from LIC9099)
Allegation #1: Facility staff are not properly trained. It is alleged staff #1 (S1) has not received the required training prior to starting at the facility. To investigate this allegation LPA Patrick Shanahan, conducted an initial complaint investigation on 10/11/2022. LPA Shanahan interviewed the administrator Janneth, and staff#4 (S4) during the visit. LPA Shanahan also reviewed and collected copies of S1’s training. LPA Rios on 03/27/2024 interview with administrator revealed she does not allow staff to work with residents until the required training and shadowing is complete. LPA Rios also conducted staff record review for the two staff present. Review of staff training records indicate S1 has the initial training required before providing care to residents. Based on interviews and record review this allegation is deemed Unsubstantiated at this time.

Allegation #2: Facility staff are not providing adequate supervision. It is alleged staff was sleeping while the residents were awake. To investigate this allegation LPA Patrick Shanahan, conducted an initial complaint investigation on 10/11/2022. LPA Shanahan interviewed the administrator Janneth, and staff#4 (S4) during the visit. Interviews on 10/11/2022 denied the allegation. On 03/27/2024 LPA Rios interviewed administrator, two (2) staff present and two (2) out of three (3) residents. Interviews with administrator and staff revealed they do not sleep or nap while providing care. Interviews with staff revealed if they need to take a break they use the staff room away from residents and not in the living room and another staff is present to cover break and lunch time. Interview with two (2) residents revealed they have no issues about the care and supervision provided. Furthermore resident interviews revealed they have not witnessed staff napping or seeping while they are awake. Based on interviews and record review this allegation is deemed Unsubstantiated at this time.
No deficiencies cited. Exit interview conducted. Report signed and delivered.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2