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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609105
Report Date: 09/02/2021
Date Signed: 09/02/2021 04:25:01 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
08/30/2021 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20210830094114
FACILITY NAME:GRANDVIEW, THEFACILITY NUMBER:
197609105
ADMINISTRATOR:FLORES, YENIFACILITY TYPE:
740
ADDRESS:2211 W 6TH STREETTELEPHONE:
(213) 380-7000
CITY:LOS ANGELESSTATE: CAZIP CODE:
90057
CAPACITY:215CENSUS: 150DATE:
09/02/2021
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Yeni Flores - AdministratorsTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff physically abused resident

Staff spoke to resident inappropriately
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit to this facility to investigate the above allegations. LPA met with Administrator Yeni Flores and explained the reason for the visit.

LPA conducted physical plant tour at 9:30 AM. Requested facility documents relevant to the investigation at 10:03 AM and interviewed the administrator, residents and staff between 10:15 AM to 1:30 PM. Regarding the allegation that the staff physically abused resident, LPA's interview with Resident #1 (R1) at 12:45 PM, revealed that there was no one else in the elevator when Staff #1 (S1) allegedly punched R1 in the right arm. S1 denied hitting or even touching R1 when they were in the elevator as they were at each corner of the elevator both facing the door during LPA's interview at 1:10 PM. Further, R1 denied any bruising on the arm that was allegedly hit by S1.

(continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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-20210830094114
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: GRANDVIEW, THE
FACILITY NUMBER: 197609105
VISIT DATE: 09/02/2021
NARRATIVE
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(continued from LIC 9099)

Regarding the allegation that the staff spoke to resident inappropriately, LPA's interview with Resident #1 (R1) at 12:45 PM, revealed that there was no one else in the elevator when Staff #1 (S1) spoke inappropriately at R1. LPA's interview with S1 revealed that while on the elevator, S1 was on the phone trying to call the administrator to report R1's behavior as directed by the administrator when S1 begins acting up. Further, S1 also denied saying anything inappropriate to R1.

Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2