<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609302
Report Date: 03/20/2023
Date Signed: 03/20/2023 09:45:11 AM

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
02/23/2023 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20230223142437
FACILITY NAME:KELLY HOUSE INCFACILITY NUMBER:
197609302
ADMINISTRATOR:TASHA KANALEYFACILITY TYPE:
735
ADDRESS:1859 UPPER COURTTELEPHONE:
(323) 635-8150
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:6CENSUS: 3DATE:
03/20/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rasheed Adetola OrenowoTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility administrator is falsifying facility staff certificate(s) training.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/20/2023, Licensing Program Analyst (LPA) Spaeth arrived at the facility to conduct an unannounced complaint visit. Upon arrival, LPA was greeted by the facility manager. LPA conducted an entrance interview and explained the purpose of the visit.

It was alleged that the administrator is falsifying facility staff certificate(s) training.

To investigate this allegation, LPA Spaeth conducted an unannounced visit on 3/01/2023 and interviewed six staff members from 9:00 am until 9:40 am. LPA interviewed the Administrator via phone call from 4:00 pm until 4:20 pm on 3/01/2023. LPA reviewed staff records from 1:00 pm until 1:30 pm on 3/01/2023. and requested training documents that are relevant to this investigation.

The six caregivers stated the Administrator did not send a text message to caregivers requesting caregivers send training certificates to the Administrator, and the Administrator did not state to caregivers that
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023
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-20230223142437
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: KELLY HOUSE INC
FACILITY NUMBER: 197609302
VISIT DATE: 03/20/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Administrator was going to alter the training records by changing the name on the training certificates. The six caregivers stated the training certificates are kept locked in the Administrator’s office.

The Administrator stated did not falsify any caregiver’s training records and stated did not ask staff members to send training certificates to the Administrator. The Administrator confirmed the certificates are safely locked in the Administrator’s office at the facility.

During LPA's visit on 3/01/2023, LPA observed the caregivers' records were safely locked within the facility.
LPA reviewed the staff members' training certificates and observed the training documents had not been altered.

Therefore the allegation is unsubstantiated. Exit interview conducted and a copy of this report was signed and delivered to facility manager.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2