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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609009
Report Date: 02/02/2024
Date Signed: 02/02/2024 02:09:39 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
01/29/2024 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20240129140020
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: 3DATE:
02/02/2024
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Yvette Cosme-AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff hit a client while in care
Staff unlawfully evicted a client while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with the administrator, Yvette Cosme, and advised her of the complaint. LPA's investigation consisted of interviews with the administrator, staff, and clients. LPA also conducted record reviews and a physical plant inspection to insure the health and safety of the clients.

Staff hit a client while in care:
In regards to the allegation, it was reported that on or around 01/16/24, Staff 1 (S1) hit Client 1 (C1), and kicked C1 out of the facility. Interviews with the administrator, and two other staff do not corroborate with the allegation. The administrator stated S1 has been employed by the facility for at least five years, and has had no disciplinary action made towards them. The two other staff that were interviewed stated they've never gotten any complaints by the other clients of S1 ever being inappropriate or physical towards them. Interviews with three of three clients do not corroborate with the allegation. No witnesses were identified to
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
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 2
Control Number 31-AS-20240129140020
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: 02/02/2024
NARRATIVE
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confirm that S1 hit C1. LPA conducted a record review and did not observe any disciplinary marks on S1's file. Review of C1's file revealed that C1 has a tendency to have an emotional outburst when C1 feels their requests are not being met, which was also mentioned during staff interview. Based on the information received, there wasn't enough evidence to prove that Staff hit a client while in care. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff unlawfully evicted a client while in care:
In regards to the allegation, a proper 30 day notification wasn't issued to C1. Interviews made do not corroborate with the allegation. According to the administrator and staff, C1 was never evicted. C1 is still present, and still a client of this facility. LPA conducted a plant inspection, and C1's belongings is still in their room. Based on the information obtained, there wasn't enough to prove that C1 was unlawfully evicted. Therefore, the allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2