197609349-1-28-2021-29-AS-JAPL-BYCS58-20210218123354

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609349
Report Date: 01/28/2021
Date Signed: 01/28/2021 04:23:27 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/21/2021 and conducted by Evaluator Aja Richardson

COMPLAINT CONTROL NUMBER: 29-AS-20210121143113

FACILITY NAME:	A BETTER LOVE BOARD AND CARE		FACILITY NUMBER:	197609349
ADMINISTRATOR:	MACANDILI, EDJESKA		FACILITY TYPE:	740
ADDRESS:	6108 SADRING AVE		TELEPHONE:	(747) 226-0439
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	6	CENSUS: 5	DATE:	01/28/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Edjeska Macandili, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Uncleared adult in the home.
Facility has bed bugs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Aja RIchardson conducted a subsequent complaint visit 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 virtually with staff Lucia Abracosa at 1pm. Administrator/Licensee Edjeska Macandilli was unavailable during the visit however was interviewed at 11 am.

Allegation #1: There are concerns that there is an adult who comes to the facility at night and is not cleared to be at the facility. To investigate this allegation, LPA conducted interviews with the Administrator and Staff, and conducted a facility tour at 1pm. According to the interview, there is an adult who is a friend of Staff who visits the facility and helps staff run errands. Interviews revealed that this individual will eat breakfast at the facility with the staff and has also spent the night at the facility 1-2 times within the last 60 days. LPA checked licensing facility personnel report report and this individual is fingerprint cleared however is not associated to this facility. Based on this information this allegation Substantiated.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja Richardson	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2021

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 29-AS-20210121143113

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: A BETTER LOVE BOARD AND CARE	FACILITY NUMBER: 197609349
	VISIT DATE: 01/28/2021

NARRATIVE

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Allegation #2: There are concerns that facility has bedbugs. To investigate this allegation, LPA conducted interviews with the Administrator and Staff, and conducted a facility tour at 1pm. According to interviews with the Administrator and staff the facility has bed bugs the infested room was treated for bed bugs on 1/20/2021.

Based on this information this allegation is Substantiated.

Exit interview conducted. Deficiencies Cited. Appeal Rights given. Signature requested by Administrator.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja Richardson	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20210121143113

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: A BETTER LOVE BOARD AND CARE	FACILITY NUMBER: 197609349
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/28/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/29/2021 Section Cited CCR 87355(e)(2)	1 2 3 4 5 6 7	Criminal Record Clearance:All individuals subject to a criminal record review shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator has agreed to have a transfer request submitted by POC due date.
	8 9 10 11 12 13 14	Based on interviews conducted, facility failed to associate indvidual which causes an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
Type B 01/28/2021 Section Cited CCR 87468(a)(2)	1 2 3 4 5 6 7	Personal Rights. Each resident shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	POC cleared during visit. Administrator submitted photos of room being cleaned painted and invoice for bed bug pest control
	8 9 10 11 12 13 14	Based on interviews facility failed to keep beg bugs from infesting the facility and this is a potential personal rights risk to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja Richardson	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2021

LIC9099 (FAS) - (06/04)

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