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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609009
Report Date: 11/15/2023
Date Signed: 11/15/2023 02:17:36 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
11/08/2023 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20231108141652
FACILITY NAME:ELWYN CALIFORNIA - YARMOUTHFACILITY NUMBER:
197609009
ADMINISTRATOR:TAYO LABEODANFACILITY TYPE:
735
ADDRESS:10512 YARMOUTH AVETELEPHONE:
(818) 488-1753
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:4CENSUS: 4DATE:
11/15/2023
UNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Tayo Labeodan, Henry MatovaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff spoke inappropriately to a resident.
Staff stole a resident’s personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Gary Tan and Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPAs met with the administrator, Tayo Labeodan, and the house manager, Henry Matova. Both were advised him of the complaint. Today's investigation consisted of interviews with the administrator, staff and residents. LPAs also conducted a record review and physical plant inspection to insure the health and safety of the residents in care.

Staff spoke inappropriately to a resident:
In regards to the allegation, it was alleged that staff are rude to Residet 1 (R1), and are calling R1 names. Interviews with R1 could not confirm the allegation. R1 did not identify staff and could not identify any witneses, date and time of when this allegation could have occurred. LPA attempted to interview the oter three residents, but could not confirm with the other three residents the allegation as these residents are lower functioning and unable to answer the LPA's questions. Interviews with staff also deny the allegation of
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
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 2
Control Number 31-AS-20231108141652
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: ELWYN CALIFORNIA - YARMOUTH
FACILITY NUMBER: 197609009
VISIT DATE: 11/15/2023
NARRATIVE
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staff speaking inappropriately to the resident. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff speaking inappropriately to a resident. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff stole a resident’s personal belongings:
In regards to the allegation, it was reported that a staff stole R1's dice from their board games. Interviews with R1 could not confirm the allegation. R1 could not identify staff that stole the dice, nor identify any witnesses that could have observed the dice taken. R1 also could not state the date and time of when this incident could have occurred. LPA attempted to interview the other three residents, but could not confirm with the other three residents the allegation as these residents are lower functioning and unable to answer the LPA's questions. Interviews with staff also deny the allegation of staff stealing R1's dice. Review of R1's file reveal that R1 did not have an inventory list of their personal belongings. According to the administrator, R1 declined to complete and inventory list when admitted on October 4, 2017. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff stealing a resident's personal belongings. Therefore, the allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2