197609010-9-7-2022-31-AS-NMAN-CSZUJD-20230621153723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609010
Report Date: 09/07/2022
Date Signed: 09/07/2022 01:14:18 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
09/02/2022 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20220902100426

FACILITY NAME:	ELWYN CALIFORNIA - INDEX		FACILITY NUMBER:	197609010
ADMINISTRATOR:	TAYO LABEODAN		FACILITY TYPE:	735
ADDRESS:	17328 INDEX ST		TELEPHONE:	(626) 500-1430
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	4	CENSUS: 4	DATE:	09/07/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	TAYO LABEODAN		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Staff forced resident do a chore at an inappropriate time which resulted in resident falling.

Staff blocked doorway to resident's room with a chair.

Resident not accorded dignity in relationships with staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in response to the above mentioned allegations. LPA was greeted by the facility administrator and explained the reason for the visit.

Allegation 1. Staff forced resident do a chore at an inappropriate time which resulted in resident falling.
LPA was able to speak with four staff and the facility administrator regarding this allegation at about 11:30 AM. Staff interviewed, stated that residents are given chores and encouraged to complete them, but they have never witnessed a staff force a resident to complete a chore. The administrator states that all residents are encouraged to complete daily tasks, yet none of the residents are ever forced. The administrator provided the LPA with daily progress notes for the client in question and progress notes from the staff present on the day in question. There was no documentation or notes written regarding a fall or inappropriate behavior. Based on interviews conducted with staff and the administrator, as well as a review of daily progress reports, this allegation is deemed to be unsubstantiated.
Continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

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 31-AS-20220902100426

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 - INDEX	FACILITY NUMBER: 197609010
	VISIT DATE: 09/07/2022

NARRATIVE

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Allegation 2. Staff blocked doorway to resident's room with a chair.
LPA was able to interview four staff members and the administrator in response to this allegation. LPA was also able to review the daily progress notes on the day of the incident for the client in question. All staff interviewed denied ever seeing a staff member block a clients access out of their room. All staff interviewed confirmed that a clients door is only closed when the client is asleep or if the client is exhibiting a behavior that requires the door to be closed for the protection of other clients. A review of progress notes for the day in question do not mention any behaviors or a resident being denied access from their room.
Based on interviews conducted and a review of daily progress notes, this allegation is deemed unsubstantiated

Allegation 3. Resident not accorded dignity in relationships with staff.
LPA was able to speak with one client and four staff members in response to this allegation. The client interview was conducted in the residents room. The client interviewed confirmed that the staff in question is nice and talks to the client with respect. All staff interviewed also confirmed that the residents are treated with respect. All staff interviewed denied ever witnessing any staff act in a disrespectful manner to any of the clients in care.
Based on Interviews with a client and facility staff, this allegation is deemed to be unsubstantiated at this time.

Exit interview conducted and report issued.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

LIC9099 (FAS) - (06/04)

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