197607943-9-30-2022-29-AS-JAPL-CK6RWT-20221013132337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607943
Report Date: 09/29/2022
Date Signed: 09/30/2022 12:00:13 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
08/25/2022 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20220825094853

FACILITY NAME:	VIRGINIA CATALINA LLC		FACILITY NUMBER:	197607943
ADMINISTRATOR:	KEVIN SCANLAN		FACILITY TYPE:	735
ADDRESS:	7000 MORSE AVENUE		TELEPHONE:	(818) 394-9878
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	4	CENSUS: 4	DATE:	09/29/2022
		UNANNOUNCED	TIME BEGAN:	10:38 AM
MET WITH:	Kevin Scanlan		TIME COMPLETED:	12:39 PM

ALLEGATION(S):

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Facility staff hit resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent unannounced visit to investigate the allegation above. The LPA arrived at the facility at 10:35 a.m., spoke with the Administrator Kevin Scanlan on the phone, and explained the reason for the visit.

On 09/01/2022, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced visit to investigate the allegation above. The LPA arrived at the facility at 1:35 p.m., met with facility staff, and explained the reason for the visit. Staff stated that the licensee is currently away at a conference and will return on Wednesday September 7, 2022. At 1:40 p.m., the LPA and the staff conducted a brief tour of the facility. No deficiencies were noted during the tour. From 1:50 p.m. to 2:15 p.m., the LPA interviewed one staff, and one out of three residents present at thefacility. From 2:15 p.m. to 2:40 p.m. the LPA conducted record review.
Continues on LIC 9099 C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

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 29-AS-20220825094853

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: VIRGINIA CATALINA LLC	FACILITY NUMBER: 197607943
	VISIT DATE: 09/29/2022

NARRATIVE

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On the allegation that ‘Facility staff hit resident while in care’. The Reporting Party (RP) stated that they received an allegation from R1 which stated that a facility staff had ‘hit’ them. To investigate the allegation, on 09/01/2022 at 11:58 a.m., the LPA interviewed the RP. The RP stated that R1 has a history of fabrication, and ‘seeking attention behavior’. When the LPA asked the RP to elaborate on the statement of ‘seeking attention behavior’, the RP stated that R1 sometimes has pretended to fall, or limp, when neither happened nor there was anything wrong with R1’s foot/leg. According to the RP, R1 has been attended the day program for three (3) years. Per the RP, lately R1’s attention seeking behavior has increased. On 08/24/2022, the R1 reported to a day program staff that a facility staff had spanked and kicked them. The the day program staff conducted a visual evaluation of the area (buttocks) where R1 allegedly was hit by facility staff. The day program staff stated that they looked for discoloration or marking in the area, however none were noted. Additionally, the day program staff stated that the next day, R1 stated, ‘I told a lie’. When asked about the ‘lie’, the R1 stated they lied about the allegation of being hit. R1 did not provide an explanation as to why they had lied. The LPA asked the RP if the R1 had mentioned the time, and place of the incident, and the RP stated that R1 had not. At 1:55 p.m., the LPA attempted to interview two residents at the facility on the day of the visit, however one resident was not responsive to the questions asked by the LPA, and the other resident was occupied with a zoom meeting with a provider. The LPA interviewed one resident who stated that they were doing well, and everything is ok, although sometimes some of the residents listen to their music very loud, and they don’t like that. At 2:00 p.m., the LPA interviewed one facility staff. Per the facility staff, there is no facility staff named, ‘Lou’. The S1 stated that they do not discipline residents.

Continues on LIC 9099C...

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220825094853

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: VIRGINIA CATALINA LLC	FACILITY NUMBER: 197607943
	VISIT DATE: 09/29/2022

NARRATIVE

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On 09/01/2022, the LPA conducted a facility personnel roster review, and did not find the name stated by R1 in the personnel list, nor any facility records. On 09/29/2022, the LPA interviewed R1 about the alleged incident; R1 denied the incident, and said that they had lied, and offered no explanation as to why they lied. R1 could nto not answer the where, when and why questions asked by the LPA. The LPA also interviewed the administrator on 9/29/2022, and the interview revealed that although there is no employee named ‘Lou’, the R1 refers to S1 by the nickname 'Lou', because R1 finds it difficult to say the name of S1. Additionally, the Administrator indicated that R1’s behavior has become more challenging(seeks constant attention and reaffirmation), perhaps due to attending the day program only two days a week in person, and one day via the computer. The R1 requires more outside stimulation, and the administrator is seeking a day program that offers five days a week in person attendance. The administrator stated that they have requested additional assistance from the Regional Center for behavioral support, but the Regional Center has not provided the support requested. The administrator added that they, and staff work with R1 by providing positive reinforcement, and provide support to address the needs of the R1.

Based on the information obtained through interviews, and record review, there is insufficient evidence to support the allegation that a ‘Facility staff hit resident while in care’. Therefore, this allegation is deemed to be Unsubstantiated at this time.

No citations were issued. Exit interview was conducted with the administrator. Facility representative signed off the report. A copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

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