197607880-2-4-2022-31-AS-NGID-CBRVVG-20220218154615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607880
Report Date: 02/04/2022
Date Signed: 02/04/2022 11:12:59 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
06/10/2021 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20210610165203

FACILITY NAME:	FOUNTAINVIEW AT EISENBERG VILLAGE		FACILITY NUMBER:	197607880
ADMINISTRATOR:	HERNANDEZ,AMBER		FACILITY TYPE:	741
ADDRESS:	6440 WILBUR AVENUE		TELEPHONE:	(818) 774-3000
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	216	CENSUS: 102	DATE:	02/04/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Adam Pena		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Resident was financially abused while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in order to complete the investigation for the above mentioned allegation. LPA was greeted by the facility administrator and was allowed entry into the facility once all covid protocols were completed.

Allegation - Resident was financially abused while in care.
It was reported that facility staff financially abused a resident in care (R1). The LPA was able to interview staff, R1, and R1's responsible party in order to come to the findings. During the course of the investigation, interviews and facility documentation showed that R1 was financially abused, however the staff in question was a private care giver and not a facility staff. The care giver in question was hired independently of the facility and through a private staffing agency. On 6/10/2021, the care giver in question and this allegation were cross reported to local law enforcement as well as the Long Term Care Ombudsman.
Based on documentation received and interviews conducted, this allegation is deemed Unsubstantiated at this time. Exit interview conducted and report issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022

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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