197608471-9-7-2023-31-AS-EMIR-DBSUKU-20241209143944

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608471
Report Date: 09/07/2023
Date Signed: 09/07/2023 11:29:43 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
08/31/2023 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20230831114352

FACILITY NAME:	BOOTS BETTER LIVING II		FACILITY NUMBER:	197608471
ADMINISTRATOR:	STACI JORDAN		FACILITY TYPE:	735
ADDRESS:	42444 BUTTERSCOTCH LANE		TELEPHONE:	(323) 394-9906
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	6	CENSUS: 6	DATE:	09/07/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Will Jordan / Licensee		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff yell at resident
Staff do not allow resident to enter the facility

INVESTIGATION FINDINGS:

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On 09/07/2023 Licensing Program Analyst (LPA) Evelin Rios made an unannounced subsequent visit to deliver determinations on the above allegations. LPA arrived to the facility and was greeted by staff #2 (S2) and S2 informed LPA they would contact the administrator. LPA was granted access to the facility. Licensee Will Jordan arrived shortly after and LPA explained the reason for the visit. An entrance interview was conducted.

At approximately 09:00 a.m. LPA conducted interviews with four (4) out six (6) residents that were home during LPA's visit. At approximately 9:30 a.m. LPA interviewed S2. At approximately 9:50 a.m. LPA requested and reviewed supporting documents to assist with the complaint investigation.

Allegation #1: Staff yell at resident.
In regards to the allegation is was reported that staff yell at R1.
To investigate the allegation LPA conducted interviews on 09/05/2023 and today with the staff, and residents present at the facility. (Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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 31-AS-20230831114352

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BOOTS BETTER LIVING II	FACILITY NUMBER: 197608471
	VISIT DATE: 09/07/2023

NARRATIVE

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On both days, according to three (3) out of the four (4) residents interviewed they report staff have not yelled or screamed at them; nor have they witnessed staff yell or scream at other residents. The same residents reported no issues or concerns with the staff or the facility. No witnesses identified to the allegation. Nor was there a place, date and time given. Interviews with staff and residents could not confirm that R1 was yelled at by staff. Based on interviews and record review, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Allegation #2: Staff do not allow resident to enter the facility.
In regards to the allegation is was reported that R1 was not allowed to enter the facility.
To investigate the allegation LPA conducted interviews on 09/05/2023 and today with the staff, including the administrator, staff from Day Program and residents present at the facility. Interview with administrator and R1's Day Program case manager Juan Chavez state, on 08/29/2023 R1 was picked up by Day Program staff. R1 then reported to Day Program staff they were not feeling well. Day Program staff and case manager attempted to contact facility. Day program staff then drove R1 back to the facility but R1 could not gain access. Failure to reach administrator resulted in R1 taken to Day Program. Interview with administrator and case manger corroborate R1 would not have been denied access to the facility had Day Program been able to reach administrator to make notification. According to administrator contact number for facility had changed and Day Program did not have the updated phone number. According to staff and resident interviews R1 and other residents attending the same day program returned to the facility when Day Program was over with no incident. Based on interviews and record review this allegation is deemed Unsubstantiated at this time.

No deficiencies issued at this time. Report signed and delivered. Exit interview conducted.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC9099 (FAS) - (06/04)

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