197608218-10-17-2022-31-AS-NGID-CLUQHN-20221206111123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608218
Report Date: 10/17/2022
Date Signed: 10/17/2022 10:55:15 AM

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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/07/2022 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20221007153109

FACILITY NAME:	ELYSIUM RESIDENTIAL CARE		FACILITY NUMBER:	197608218
ADMINISTRATOR:	JENNETH AGUILAR		FACILITY TYPE:	740
ADDRESS:	11436 OSTORM AVENUE		TELEPHONE:	(818) 620-2202
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 6	DATE:	10/17/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Jenneth Aguilar/ Administrator		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility Staff are not properly trained

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in response to the above mentioned allegation. The LPA was greeted by the facility administrator and had his temperature taken and all COVID-19 questions asked before the LPA was allowed entry. LPA explained the reason for the visit.
Allegation 1. Facility Staff are not properly trained
The LPA was able to interview staff, residents and the administrator regarding this allegation. The LPA also conducted a file review on the staff currently at the facility. At the time of the visit there were 2 staff working and the administrator. Both staff confirmed that all training is conducted before they are allowed to work and continuous in-service training's are conducted throughout the year. The administrator also confirmed that staff are fully trained before being allowed to work with residents. Facility documents revealed that both staff had received training prior to employment. Resident interviews revealed that they are treated well and no complaints were reported.
Based on interviews and facility staff record reviews, this allegation is deemed unsubstantiated.
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: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

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 3