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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608661
Report Date: 08/28/2024
Date Signed: 08/28/2024 04:46:49 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
08/22/2024 and conducted by Evaluator Angela Barutyan
COMPLAINT CONTROL NUMBER: 29-AS-20240822111237
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:
08/28/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Christian OkpalaTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff speak to client in an inappropriate manner
Staff do not treat clients with dignity and respect
Staff did not seek timely medical care for client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Barutyan conducted a joint visit with North Los Angeles County Regional Center (NLACRC), Quality Assurance Specialists (QASs) Lisseth Carrillo and Miguel Aguilar on a complaint visit at the facility today. At 09:15AM, the LPA and QASs met with staff and explained the reason for the visit. The Administrator, Christian Okpala was not immediately available and arrived around 10:35AM.

During today’s visit, LPA and QASs conducted staff interviews between 09:20AM-12:40PM, administrator interview at 10:47AM, reviewed and obtained pertinent documents between 10AM-1PM, and conducted a physical plant tour at 12:43PM.

Continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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
Control Number 29-AS-20240822111237
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ELWYN NC - KELVIN 1
FACILITY NUMBER: 197608661
VISIT DATE: 08/28/2024
NARRATIVE
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Regarding the allegations: Staff speak to clients in an inappropriate manner and staff do not treat residents with dignity and respect.

On 08/22/2024, the Department received a complaint alleging staff speak to clients in an inappropriate manner and staff do not treat residents with dignity and respect. During today’s staff interviews, administrator interview, and record review, it was revealed that Staff 1 (S1) has had a history of misconduct and has been observed to speak in an inappropriate manner to clients and other staff. In addition, LPA interviewed a credible witness (CW) on 08/27/2024 who provided detailed descriptions of a specific incident they observed. Based on the interviews of staff, administrator, and a credible witness, and record review, these allegations are deemed Substantiated at this time.

It was also alleged that staff did not seek timely medical care for client. Additional information received by CW reported that the facility has been sending Client 1 (C1) to adult day program without medications or treatments for a gastro-intestinal (GI) issue C1 has been experiencing for multiple weeks. During record review and interviews, between 10:50AM-1PM, the LPA and QASs observed that C1 has not been receiving medical care for their GI issues. The facility has not spoken with C1’s physician or pharmacies to provide treatment. Medication review around 11:40AM revealed that the facility has been attempting to treat C1’s GI issues through use of PRN medications that counteract C1’s prescribed medications to be taken daily. Further review of the medication information pamphlet revealed that the prescribed medication should not be taken if there has been a change in bowel movements for two (2) weeks or longer. However, the facility has continued to administer the prescribed medication and has not contacted a physician or pharmacy regarding C1’s change in condition. Based on record review and interviews conducted, the allegation of “staff did not seek timely medical care for client” is deemed Substantiated at this time.


Per the California Code of Regulations, Title 22, Division 6 and California Health and Safety Code the following deficiencies were observed and cited during the visit (See 9099-D).

Exit interview conducted. A copy of the report and appeal rights were provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240822111237
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ELWYN NC - KELVIN 1
FACILITY NUMBER: 197608661
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2024
Section Cited
CCR
80072(a)(1)
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(a) Except for children's residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(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 conducted an in-service training on personal rights on 08/23/2024. Administrator will be closely monitoring the staff and is also conducting an internal investigation with company HR to determine staff's standing with the facility and will email findings to CCL by 09/13/2024.
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Based on record review and interviews, the Licensee did not comply with the section cited above in that a staff member has been observed by staff, clients, and credible witnesses to speak inappropriately to and around clients. This poses a potential personal rights risk to persons in care.
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Type B
09/13/2024
Section Cited
CCR
85075(b)
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(b) The facility shall develop and implement a plan which ensures that assistance is provided to the clients in meeting their medical and dental needs.

This requirement is not met as evidenced by:
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Administrator contacted physician to update client's medication during time of visit. Client has an appointment with physician for 09/11/2024. Administrator will have a registered nurse provide an in-service training and will provide sign in sheets to CCL by 09/13/2024.
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Based on record review and interviews with a credible witness, the Licensee did not comply with the section cited above in that the facility did not seek medical care in a timely manner for a persistent health issue of a client. This poses a potential health, safety, and personal rights risk to persons 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: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3