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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608023
Report Date: 09/14/2023
Date Signed: 09/14/2023 02:17:03 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
08/29/2023 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20230829150810
FACILITY NAME:SUNGATE CARE FACILITYFACILITY NUMBER:
197608023
ADMINISTRATOR:TASHA KANALEYFACILITY TYPE:
735
ADDRESS:3441 SUNGATE DR.TELEPHONE:
(661) 526-7848
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:4CENSUS: 4DATE:
09/14/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Dolly BarrazaTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff yelled at a resident while in care.
Staff hit a resident while in care.
Staff put soap in a resident's mouth while in care.
INVESTIGATION FINDINGS:
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On 9/14/2023 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth was met by Dolly Barraza. LPA explained the purpose of this visit was to deliver findings for this complaint.

The investigation consisted of the following: On 8/31/2023, LPA Spaeth conducted a 10-day visit, toured the physical plant, interviewed residents, and reviewed and requested residents’ documents. LPA Spaeth requested the following documents: 1) resident roster, 2) staff phone numbers, and 3) C1’s IPP. All documents were received at the time of visit. On 9/01/2023, LPA interviewed five staff members via phone call.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
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-20230829150810
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: SUNGATE CARE FACILITY
FACILITY NUMBER: 197608023
VISIT DATE: 09/14/2023
NARRATIVE
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The investigation revealed the following: Regarding the allegation… Staff yelled shut your mouth at C1 while in care. LPA Spaeth interviewed residents C1 and C2 who stated a staff member has not yelled at them and they never witnessed a staff member yelling at another resident. The five staff members who were interviewed stated they have never yelled at a resident and have not witnessed another staff member yelling at a resident.


Regarding the allegation, Staff hit a resident in the face while in care . LPA Spaeth interviewed residents C1 and C2 who stated a staff member has never hit them in the face and stated they never witnessed a staff member hitting another resident in the face. The five staff members who were interviewed stated they have never hit a resident in the face and they have not witnessed another staff member hitting another resident in the face.

Regarding the allegation, Staff put soap in a resident’s mouth while in care. LPA Spaeth interviewed residents C1 and C2 who stated a staff member has never put soap in their mouth and stated they never witnessed a staff member putting soap in another resident’s mouth. The five staff members who were interviewed stated they have never put soap in a resident’s mouth and they have not witnessed another staff member putting soap in another resident’s mouth.

Based on LPA’s interviews conducted, the preponderance of evidence standard has not been met. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted, and a copy of the report was given to the caregiver.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2