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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608661
Report Date: 02/04/2025
Date Signed: 02/04/2025 03:15:20 PM

Unsubstantiated


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
03/07/2024 and conducted by Evaluator Angela Barutyan
COMPLAINT CONTROL NUMBER: 29-AS-20240307151329
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:
02/04/2025
UNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:Martin SekajugoTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff pushed resident in care.
Staff spoke to resident in an inappropriate manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation with the purpose of delivering findings for the allegations listed above at 03:03PM. LPA met with staff Martin Sekajugo who was designated to sign today’s report. Reason for the visit was explained.

During the initial visit on 03/14/2024 beginning at 09:39AM, LPA T. Camara conducted interviews with staff at 9:57AM and 10:49AM, conducted an interview with a client at 10:30AM as all other clients were out of the facility, and conducted a record review at 11:27AM.

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

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
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 29-AS-20240307151329
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: 02/04/2025
NARRATIVE
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It was alleged that Staff #1 (S1) pushed Resident #1 (R1) and spoke to R1 in an inappropriate manner. Interviews conducted with staff and client and records reviewed during the initial visit did not include evidence supporting the allegations. However, during a separate and unrelated complaint investigation conducted on 08/28/2024 (Complaint Control #29-AS-20240822111237), LPA Barutyan substantiated two allegations relating to the allegations of this complaint: staff speak to client in an inappropriate manner and staff do not treat clients with dignity and respect. During the visit on 08/28/2024, information obtained through staff interviews, client interview, and record review, revealed that S1 had a history of misconduct, with a final warning issued on 06/11/2024, and had been observed to speak in an inappropriate manner to clients and other staff. In addition, LPA Barutyan interviewed a credible witness (CW) on 08/27/2024 who provided detailed descriptions of a specific incident they observed where S1 spoke to Resident #2 (R2) in an inappropriate manner and did not treat R2 with dignity and respect. As a plan of correction for deficiencies cited on 08/28/2024, previous Administrator Christian Okpala conducted an in-service training on personal rights on 08/23/2024 and an internal investigation was conducted with company HR that resulted in the termination of S1’s employment on 10/04/2024. Information obtained through interview and record review for this investigation did not include evidence sufficient to corroborate the allegations that S1 pushed R1 and spoke to R1 in an inappropriate manner. Although the allegations may have happened or are valid, there is not sufficient evidence to prove the alleged violations did or did not occur, therefore they are deemed UNSUBSTANTIATED at this time.

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

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC9099 (FAS) - (06/04)
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