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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609483
Report Date: 09/23/2024
Date Signed: 09/23/2024 03:22:23 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
09/17/2024 and conducted by Evaluator Antonia Alvizar-Ettima
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20240917102958
FACILITY NAME:GRANDEURFACILITY NUMBER:
197609483
ADMINISTRATOR:JOEY S. PEREZFACILITY TYPE:
735
ADDRESS:2463 GRANDEURTELEPHONE:
(855) 302-3331
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY:4CENSUS: 4DATE:
09/23/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Co Administrator Juana Ivett Busby and Cindy GarciaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff kicked resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced initial visit for the above noted allegation. LPA met with Co- Administrators and granted entry. The purpose of the visit was discussed.

At approximately 11:10a.m. LPA request and received staff and resident rosters. At 1:45a.m. LPA and Busby conducted a physical plant tour. Between 11:30a.m. – 12:30a.m LPA interviewed Co- Administrators, staff including resident (R1) in the facility. At approximately, 12:25p.m. LPA request and received R1 Information and Emergency Information, Living Options Committee Notes and Referral Summary, Individual Program Plan (IPP), Unusual Incident Report, Daily Notes and San Gabriel/Pomona Regional Center investigation finding. Between 12:30a.m. – 1:00p.m. LPA interviewed two (2) staff via-phone. LPA asked questions relevant to the nature of the complaint. At 1:30p.m. LPA reviewed documents obtained. Between 2:00p.m. -2:20p.m. LPA interview residents (R1-R1) in the facility.
Staff kicked resident.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024
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-20240917102958
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GRANDEUR
FACILITY NUMBER: 197609483
VISIT DATE: 09/23/2024
NARRATIVE
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It is alleged that resident R1 threw a cup of juice at staff S1 and that S1 kicked R1 in the groin in response. LPA attempted to interview resident R1 however refused to talk and indicated that they are okay with S1. R1 indicated that S1 was trying to protect themselves when they threw the juice at S1. Other residents also verified that S1 does not kicked R1. Resident indicated that staff are nice, helpful and have no concerns about staff kicking them. Staff interviews reveal that S1 never kicked R1 staff S1 and S2 only performed a Cris Prevention Intervention (CPI) hold for 15 minutes with interval release when R1 became aggressive. S1 indicated that the CPI was used to prevent R1 from hurting staff and/or other residents in the facility. R1 became physically aggressive after a called failed with his parent. S1 indicated that they never kicked R1 or will kick other residents as a response to when residents are experiencing behavior issues. Co – Administrator Busby indicated that San Gabriel/Pomona Regional Center conducted an investigation regarding the allegation on 09/19/2024. During today’s visit LPA did not observe staff abusing residents.


Based on interviews, observation and record review there is an insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazard is noted during this visit.


Exit interview is conducted and copy of report was provided to Co – Administrator.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024
LIC9099 (FAS) - (06/04)
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