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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609349
Report Date: 05/20/2021
Date Signed: 05/20/2021 01:27:34 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
05/12/2021 and conducted by Evaluator Aja Richardson
COMPLAINT CONTROL NUMBER: 29-AS-20210512091553
FACILITY NAME:A BETTER LOVE BOARD AND CAREFACILITY NUMBER:
197609349
ADMINISTRATOR:MACANDILI, EDJESKAFACILITY TYPE:
740
ADDRESS:6108 SADRING AVETELEPHONE:
(747) 226-0439
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 4DATE:
05/20/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jade Maniwang, Ass. AdministratorTIME COMPLETED:
01:35 PM
ALLEGATION(S):
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Facility property is unkempt.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Aja Richardson conducted an unannounced initial complaint visit regarding the above allegation. LPA arrived at the facility 11:30 am and met with Assistant Administrator Jade Maniwang and explained the reason for the visit.
To investigate the above allegation, LPA Richardson conducted a facility tour at 11:35 am. At 11:36 am, LPA Richardson observed yard tools with sharp objects in the back yard as well as a numerous trash bags in shopping carts and throughout the back yard. At 11:40 am, LPA Richardson observed residents rooms to be messy with resident items on the floor and not in order. LPA also observed the resident bathroom to be in disarray. LPA spoke with the staff who stated they are in the process of cleaning out the house and may be closng the faciity however a final decision has not been made. LPA Richardson reminded designated staff that if they choose to close the facility a 60 day written notice would need to be given to resident and closure plan submitted to licensing. Based on LPA observations of faciity being unkempt this allegation is Substantiated. Exit interview conducted. Report emailed to the Administrator.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja RichardsonTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2021
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 3
Control Number 29-AS-20210512091553
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: 05/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2021
Section Cited
CCR
87303(a)
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Maintenance and Operation: 87303(a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
This requirement was not met as evidenced by
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Administrator secured garden tools immediately.
and
trash will be discarded and residents rooms cleaned by POC due date.
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Based on observation, facility failed to secure sharp garden tools and throw away that was observed throughout facility. Also residents rooms and bathrooms were in disarray which poses an immediate risk to residents in care.
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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 PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja RichardsonTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
05/12/2021 and conducted by Evaluator Aja Richardson
COMPLAINT CONTROL NUMBER: 29-AS-20210512091553

FACILITY NAME:A BETTER LOVE BOARD AND CAREFACILITY NUMBER:
197609349
ADMINISTRATOR:MACANDILI, EDJESKAFACILITY TYPE:
740
ADDRESS:6108 SADRING AVETELEPHONE:
(747) 226-0439
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 4DATE:
05/20/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jade ManiwangTIME COMPLETED:
01:35 PM
ALLEGATION(S):
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Residents are not getting assistance with ADLs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Aja Richardson conducted an unannounced initial complaint visit regarding the above allegation. LPA arrived at the facility 11:00 am and met with Staff Jade Maniwang and explained the reason for the visit.
To investigate the above allegation, LPA conducted a facility tour at 11:35 am. During the tour LPA RIchardson interviewed 3 out of 4 residents and staff currently working at facility. The resident that was not interviewed was not at the facility during the visit. The interviews with residents revealed that they are happy with the care they are receiveing. LPA observed the residents in care they they appeared well groomed and cared for. Based on interviews with residents and LPA observations the allegations that residents are not getting assistance with ADL's is Unsubstantatied.

Exit interview conducted. Report emailed to Administrator.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja RichardsonTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3