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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609483
Report Date: 11/16/2022
Date Signed: 11/16/2022 02:15:53 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
06/10/2022 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20220610141124
FACILITY NAME:GRANDEURFACILITY NUMBER:
197609483
ADMINISTRATOR:SMITH, JASONFACILITY TYPE:
735
ADDRESS:2463 GRANDEURTELEPHONE:
(855) 302-3331
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY:4CENSUS: 4DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ivett Busby, StaffTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff hit resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced subsequent visit to deliver the findings for the above noted allegation. LPA met with staff Ivett Busby and the purpose of the visit was discussed.

It was reported that staff slapped client in the face. To investigate this allegation on 6/15/2022 between 2:30pm and 3:30pm staff and client interviews were initiated. Staff interviews revealed that Client #1 (C1) has a history of making false accusations and exhibiting aggressive behaviors towards staff and clients. On 6/08/2022, C1 was sitting next to Staff #1 (S1) watching a movie while eating Hot Cheetos. C1 wiped their hand on S1. When C1 attempted to wipe their hand on S1's arm again, S1 corrected their behavior. C1 became very upset over this and then proceeded to punch a wall and threatened to get staff fired.

Continue on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
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-20220610141124
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: GRANDEUR
FACILITY NUMBER: 197609483
VISIT DATE: 11/16/2022
NARRATIVE
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On 11/08/2022, between 11:00am and 12:30pm, LPA reviewed facility files. The information contained in the files confirmed what staff had told LPA. LPA also read the investigative report from the Regional Center. The Regional Center's findings regarding this case were unsubstantiated.

Based on interview and record review there is not sufficient information to support this allegation. Therefore, this allegation is deemed UNSUBSTANTIATED at this time;
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2