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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608661
Report Date: 05/26/2023
Date Signed: 05/26/2023 02:30:40 PM

Substantiated


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
03/16/2023 and conducted by Evaluator Ashley Smith
COMPLAINT CONTROL NUMBER: 29-AS-20230316100010
FACILITY NAME:ELWYN NC - KELVIN 1FACILITY NUMBER:
197608661
ADMINISTRATOR:BRANDY C MAYNARDFACILITY TYPE:
735
ADDRESS:5651 KELVIN AVETELEPHONE:
(747) 900-6742
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:4CENSUS: 4DATE:
05/26/2023
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Crystal CortesTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Staff do not treat clients with dignity and respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ashley Smith conducted a subsequent visit to the above facility to deliver findings of an investigation completed by LPA Angel Ascencio. The LPA met with Crystal Cortes at 2:10 p.m. Entrance interview conducted.

On 03/16/2023, the Department received a complaint alleging that staff do not treat clients with dignity and respect. On 03/23/2023, interview with Staff #1 (S1), starting at 2:20 p.m. revealed that they have not heard of any staff yelling or disrespecting clients at the home. Additionally, S1 added that the clients at the home present various behaviors. S1 claimed that S1 does not yell or give clients attitude, and ultimately indicated that they speak to clients while being firm and in a calm manner. Lastly, S1 added that clients have accused S1 of yelling at them, but in the end, apologize to S1 for their behaviors.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
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 5
Control Number 29-AS-20230316100010
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: ELWYN NC - KELVIN 1
FACILITY NUMBER: 197608661
VISIT DATE: 05/26/2023
NARRATIVE
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Client interviews were conducted on 03/23/2023, starting at 02:30 p.m., which revealed that most staff are good, professional, and understanding.

Client interviews indicated that S1, on various occasions, does not yell at clients, but talks to clients in a manner that is degrading, without dignity and respect. Additionally, clients added that clients feel unsupportive and belittled by S1 and their actions on a daily basis. Clients indicated there have been instances where clients request food/snacks or request their Personal and Incidental funds (P&I) for shopping, yet S1 degrades client for the additional food or funds. That same day, starting at 03:40 p.m. staff interviews were conducted confirming what clients stated. Additionally, staff interviews added that because of S1 not treating the clients with respect and dignity, clients get triggered, which causes them to have ongoing, challenging behaviors. Also, staff interviews stated that Administrator Brandy Maynard is aware of S1’s way of speaking to clients, as it has been brought up to the Administrator attention. Lastly, staff interviews stated that although S1 is a hard-working staff member, S1 would benefit from additional training on dignity, respect and how to communicate with clients that present with varying needs. Interview with Administrator Brandy Maynard, at 04:25 p.m., revealed that they are unaware of S1 behaviors as staff or clients have not brought it up to the Administrator attention.

That same day, on 03/23/2023, and on an annual visit on 05/04/2023, LPA Ascencio overheard S1 not treating client with dignity and respect during various interactions. S1’s tone in speaking with clients was very curt and discourteous, and S1 would regularly interrupt clients when they were making requests to S1. Although interviews indicated that S1 does not yell at clients, S1’s way of speaking to clients has been observed by clients and staff as belitting, causing an increase in behaviors that could have been avoided. Thus, based on evidence gathered through the investigation, there is enough evidence to support the claim that staff do not treat clients with dignity and respect. This allegation is substantiated

Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D).



Exit interview and report reviewed with the Administrator. A copy of the report and appeal rights were issued.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20230316100010
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: ELWYN NC - KELVIN 1
FACILITY NUMBER: 197608661
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2023
Section Cited
CCR
80072(a)
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80072(a) Personal Rights. .. each client shall have personal rights which include, ... (1) To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as evidenced by:
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Administrator will conduct all staff training regarding code of conduct. S1 will be placed on additional training on elder abuse, how to communicate with client with behaviors, etc. Administrator will submit documents to CCL by 6/09/2023.
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Based on interviews and observations, the license did not comply with the section above as S1 does not treat clients with dignity or respect which posed a potential personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
03/16/2023 and conducted by Evaluator Ashley Smith
COMPLAINT CONTROL NUMBER: 29-AS-20230316100010

FACILITY NAME:ELWYN NC - KELVIN 1FACILITY NUMBER:
197608661
ADMINISTRATOR:BRANDY C MAYNARDFACILITY TYPE:
735
ADDRESS:5651 KELVIN AVETELEPHONE:
(747) 900-6742
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:4CENSUS: 4DATE:
05/26/2023
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Crystal CortesTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Staff yell at clients
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Ashley Smith conducted a subsequent visit to the above facility to deliver findings of an investigation completed by LPA Angel Ascencio. The LPA met with Crystal Cortes at 2:10 p.m. Entrance interview conducted.

On 03/16/2023, the Department received a complaint alleging that staff yell at clients. On 03/23/2023, interview with Staff #1 (S1), starting at 2:20 p.m. revealed that they have not heard of any staff yelling or disrespecting clients at the home. Additionally, S1 added that although the clients at the home present various behaviors, S1 does not yell or give the clients attitude, but instead being firm and talking to the clients in a calm manner. Lastly, S1 added that clients have accused S1 of yelling at them, but in the end, apologize to S1 for their behaviors.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20230316100010
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: ELWYN NC - KELVIN 1
FACILITY NUMBER: 197608661
VISIT DATE: 05/26/2023
NARRATIVE
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On 03/23/2023, interview with various staff members, starting at 2:20 p.m., revealed that they have not hear of any staff member yelling or raising their voice towards clients. Additionally, staff interviews added that the clients’ behaviors are constantly changing, and instead of arguing with clients, staff listen and reason with clients to provide the best quality care. Also, interviews with staff added that they have concern with Staff #1 (S1) not treating clients with dignity and respect, but have not heard S1 yell or scream at clients. Lastly, staff interviews stated that Administrator Brandy Maynard is aware of S1’s way of speaking to clients, as it has been brought up to the Administrator attention. That same day, client interviews, starting at 02:30 p.m., revealed that most staff are good, professional, and understanding. Client interviews indicated that S1, on various occasions does not yell at clients, but talks to clients in a manner that is degrading, without dignity and respect. Additionally, clients added that S1 is a hard worker, and they enjoy being around S1, but the way S1 talks to clients can be shameful to clients. Interview with Administrator Brandy Maynard, at 04:25 p.m., revealed that they have not heard of any staff yelling at clients, or that staff or clients have not brought it up to the Administrator's attention.

Although interviews indicated that S1’s way of speaking to clients has been observed by clients and staff to be belittling and shameful, they have not observed S1 or any staff member yell at clients. Thus, based on evidence gathered through the investigation, there is not enough evidence to support the claim that staff are yelling at clients. This allegation is unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5