197609337-12-13-2021-31-AS-MVAO-CDA28H-20220407171023

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609337
Report Date: 12/13/2021
Date Signed: 12/13/2021 11:48:51 AM

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
12/01/2021 and conducted by Evaluator Shira Stamps

COMPLAINT CONTROL NUMBER: 31-AS-20211201093156

FACILITY NAME:	MOLOCK RESIDENTIAL II		FACILITY NUMBER:	197609337
ADMINISTRATOR:	MOLOCK, JONATHAN		FACILITY TYPE:	735
ADDRESS:	43140 E 33RD STREET		TELEPHONE:	(661) 674-8592
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	4	CENSUS:	DATE:	12/13/2021
		UNANNOUNCED	TIME BEGAN:	07:15 AM
MET WITH:	Monica Vartanian, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff failed to assist resident with medications.

Facility is forcing residents to leave the facility .

Staff is verbally abusive.

Staff altered medications without resident's knowledge.

INVESTIGATION FINDINGS:

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At 7:15am Licensing Program Analyst (LPA) Shira Stamps arrived at the facility mentioned above for a subsequent complaint visit. Entrance interview conducted.

At approximately 8:30 am, LPA conducted a physical plant walk through ,and LPA did not observe any immediate health and safety issues during this visit. From 7:20am-9:20am, LPA conducted interviews with three(3) residents and three(3) staff members.

Allegation: Staff failed to assist resident with medications.

Interviews with three(3) out of three(3) staff members indicated that staff members assist all residents with their medications. Three(3) out of three(3) residents interviewed indicated that staff assist residents with their medications. Therefore, after review of the information received the allegation, “ Staff failed to assist residents with medications,” is deemed unsubstantiated. Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Shira Stamps	TELEPHONE: (818) 669-6375
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021

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-20211201093156

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: MOLOCK RESIDENTIAL II	FACILITY NUMBER: 197609337
	VISIT DATE: 12/13/2021

NARRATIVE

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Allegation: Facility is forcing residents to leave the facility.

Interviews with two(2) out of three(3) staff members indicated that residents have a choice to stay at the facility or go out into the community. Two(2) out of three(3) residents indicated they have a choice to stay at the facility; go to Molock Residential, INC; or go out into the community. Staff records showed documentation of residents choosing to stay at the facility, and not go out into the community. Based on interviews and documents collected the allegation, “Facility is forcing residents to leave the facility,” is deemed unsubstantiated.

Allegation: Staff is verbally abusive

Interviews with three(3) out of three(3) staff members indicated that staff is not verbally abusive towards residents or other staff members. Two(2) out of three(3) residents indicated that staff is not verbally abusive towards residents. Therefore, after review of the information received the allegation, “ Staff is verbally abusive,” is deemed unsubstantiated.

Allegation: Staff altered medications without resident's knowledge

Interviews with three(3) out of three(3) staff members indicated that staff supports the residents in communicating with their doctor when an alteration of medication is needed. Two(2) out of three(3) residents indicated their medications have not been altered without their knowledge, and when an alteration of medication is needed the residents contact their doctor directly with support from staff members. Therefore the allegation, “ Staff altered medications without resident’s knowledge,” is deemed unsubstantiated.

Exit interview conducted. Report delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Shira Stamps	TELEPHONE: (818) 669-6375
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021

LIC9099 (FAS) - (06/04)

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