197608636-8-18-2022-31-AS-RRAZ-CL9KW4-20221117071518

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608636
Report Date: 08/18/2022
Date Signed: 08/18/2022 02:16:25 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/05/2022 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20220805135534

FACILITY NAME:	ROYAL TRINITY ENRICHMENT CENTER		FACILITY NUMBER:	197608636
ADMINISTRATOR:	BERNARD MOSES ISIKO		FACILITY TYPE:	735
ADDRESS:	13142 CROWLEY STREET		TELEPHONE:	(747) 223-2115
CITY:	ARLETA	STATE: CA	ZIP CODE:	91331
CAPACITY:	6	CENSUS: 6	DATE:	08/18/2022
		UNANNOUNCED	TIME BEGAN:	08:33 AM
MET WITH:	Andrew Muhumuza - Alternate Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Resident was slapped by a staff member while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent visit at this facility to further investigate the above allegation. LPA met with administrator Andrew Muhumuza and explained the reason for the visit.

LPA conducted physical plant tour at around 9:00 AM, requested copies of facility documents at 9:35 AM and interviewed staff and residents between 10:00 AM to 12:15 PM.

Regarding the allegation that a resident was slapped by a staff member while in care, it was alleged that Staff #1 (S1) slap Resident #1 (R1) on the back of the neck with an open hand and the client turned around to defend self. LPA's inteview with S1 on 08/09/22 at around 10:00 AM revealed that on the day and time of the alleged incident, R1 was about to use the bathroom near the bedroom hallway which is undergoing repair due to a clog by the plumber so S1 redirected R1 to use the other bathroom located adjacent to the living room. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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 31-AS-20220805135534

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROYAL TRINITY ENRICHMENT CENTER	FACILITY NUMBER: 197608636
	VISIT DATE: 08/18/2022

NARRATIVE

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(continued from LIC 9099)

R1 was non-verbal and does not follow verbal prompts so S1 held R1 on both shoulder with a gentle tap and redirected R1 to the bathroom. S1 denied slapping R1 on the slightest. LPA's interview with staff today between 10:00 AM to 12:15 PM confirmed about the toilet being repaired that day and no staff witnessed S1 being rude or abusive or mistreated R1 or any resident. LPA's interview with aware resident on 08/09/22 at around 11:00 AM revealed that S1 was nice to everyone and did not see hurting any resident at the facility.

Based on the information gathered during this and prior visit, there is insufficient information to support the allegation and therefore deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC9099 (FAS) - (06/04)

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