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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609057
Report Date: 06/23/2020
Date Signed: 06/23/2020 03:51:18 PM



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
11/14/2019 and conducted by Evaluator Alexander Pitz
COMPLAINT CONTROL NUMBER: 31-AS-20191114150310
FACILITY NAME:PRIMROSE 2FACILITY NUMBER:
197609057
ADMINISTRATOR:NAIMUDDIN, MUBEENFACILITY TYPE:
740
ADDRESS:8115 DE SOTO AVETELEPHONE:
(323) 387-2755
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY:6CENSUS: 4DATE:
06/23/2020
UNANNOUNCEDTIME BEGAN:
03:46 PM
MET WITH:Mubeen NaimuddinTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Staff caused injury to resident.
Staff handled resident in a rough manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Pitz delivered findings for a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Mubeen Naimuddin, the facility administrator.
Allegation #1, that “Staff caused injury to resident” has been unsubstantiated based on the interviews conducted. On 11/15/19, LPA interviewed three staff members, the facility administrator, four residents and an outside party. On 1/30/20, LPA interviewed two more residents, including the alleged victim. None of the interviews indicated that any injury was sustained by Resident 1 (R1) and no corroborating evidence was obtained.
Allegation #2, that “Staff handled resident in a rough manner” has been unsubstantiated based on the interviews conducted. On 11/15/19, LPA interviewed three staff members, the facility administrator, four residents and an outside party. On 1/30/20, LPA interviewed two more residents, including the alleged victim. Five out of six residents denied ever being handled roughly, three out of three caregivers interviewed
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Alexander PitzTELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2020
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-20191114150310
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: PRIMROSE 2
FACILITY NUMBER: 197609057
VISIT DATE: 06/23/2020
NARRATIVE
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denied seeing residents handled roughly, and the relevant witness did not observe any bruising or other signs that R1 was handled roughly.
A telephonic exit interview was conducted with Administrator, and a hard copy was provided via email for signature.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Alexander PitzTELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2