197607892-10-8-2024-29-AS-DPEA-DAANM5-20241022103435

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607892
Report Date: 10/08/2024
Date Signed: 10/08/2024 02:32:09 PM

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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/12/2023 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20231012160146

FACILITY NAME:	CHRISTINE'S RETREAT		FACILITY NUMBER:	197607892
ADMINISTRATOR:	GEVORG MKRTCHIAN		FACILITY TYPE:	735
ADDRESS:	14712 KILLION STREET		TELEPHONE:	(818) 387-8572
CITY:	SHERMAN OAKS	STATE: CA	ZIP CODE:	91411
CAPACITY:	6	CENSUS: 3	DATE:	10/08/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	DSP - Rosita Ramos		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident sustained an unexplained injury while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint visit to investigate the allegation listed above. Upon arrival LPA met with Staff Rosita Ramos and explained the reason for the visit. Assistant Administrator was contacted and they stated they could not be onsite for the visit at this time, but Remedios can sign in their place.

On 08/15/2024, the initial complaint visit was conducted by LPA between approximately 01:45 p.m. - 4:00 p.m. During the visit, LPA’s conducted physical plant, interviewed staff, residents, North Los Angeles Regional Center (NLARC) Community Services Specialist (CSS) and Service Coordinator (SC), as well as, reviewed and obtained copies of pertinent documentation relevant to the investigation. Today LPA conducted physical plant, interviewed additional staff, clients, CSS, family / responsible parties of clients in care.

It was reported that a "resident sustained an unexplained injury while in care", as it was alleged that Client #1 (C1), sustained a cut on their arm due to lack of staff supervision.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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 29-AS-20231012160146

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CHRISTINE'S RETREAT	FACILITY NUMBER: 197607892
	VISIT DATE: 10/08/2024

NARRATIVE

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Continued from 9099

Interviews and record reviews indicated that C1 was unaware of how they sustained a cut, and facility staff only learned of the injury when C1 disclosed it during a scheduled visit with Regional Center staff. During this visit, C1 showed the cut and requested first aid. The cut measured approximately 2 to 3 inches long, was deep, scabbed, and inflamed. Facility staff provided immediate care for the wound, stating they were unaware of it because it had been covered by C1's clothing. A review of C1’s Individual Program Plan (IPP) dated July 26, 2024, noted that C1 requires verbal prompts and occasional physical assistance to initiate and complete activities of daily living (ADLs) such as bathing, grooming, dressing, and personal hygiene. C1 is verbal and can effectively communicate their needs and desires, including feelings of pain and discomfort, and can seek assistance from caregivers. Physician's report dated July 25, 2024, indicated that C1 does not require assistance with bathing, grooming, dressing, or toileting. Interviews with staff and C1’s family revealed that C1 tends to scratch themselves due to having dry skin. Staff have been reminded to encourage C1 to apply lotion to dry areas of skin. C1's family, the Community Support Specialist (CSS), and the Service Coordinator (SC) did not express concerns about staff causing the injury and confirmed that once staff were informed of the cut, they provided first aid promptly. A review of the staff schedule revealed there is at least two (2) caregivers scheduled per shift. During physical plants LPA observed C1 to freely move around the home with staff nearby. On 10/08/2024, at approx 12:02 p.m. LPA observed what appeared to be a healed scratch on the top of C1's left arm between the elbow and wrist. The scratch appeared to be the width of a finger nail and approx not more than 2 inches long. LPA's interview with C1 revealed they scratched their arm because it was itchy. LPA observed staff prompting C1 to pat the itchy area rather than scratch. LPA's interview with two (2) other clients in care during the time of the complaint revealed they have never observed staff cause harm to any clients in care and they did not express any concerns for staffing at this time. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation, “resident sustained an unexplained injury while in care” is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC9099 (FAS) - (06/04)

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