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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 01:23:02 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
01/11/2024 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20240111103044
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:
09:35 AM
MET WITH:Cindy Garcia, Co-AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff physically abused resident while in care
INVESTIGATION FINDINGS:
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On 09/23/24, at 9:35am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Caregiver, Ruben Davis. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather additional information, conduct staff and client interviews and deliver findings for this complaint.

On 01/16/2024, Licensing Program Analyst (LPA) Gina Saucedo and Licensing Program Manager (LPM) Troy Agard initiated the complaint investigation. On 09/23/24, LPA Saucedo asked for the census, staff, and client rosters. On 09/23/24, LPA Saucedo interviewed staff and clients, conducted a physical tour, gathered additional information, and delivered findings.

LIC 9099-Continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
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-20240111103044
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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Regarding the allegation: Staff physically abused resident while in care. It is being alleged that staff physically hit a client. Four (4) out of four (4) staff have confirmed that Client #1 (C1) had behavior issues and was very aggressive. LPA was able to confirm through the Unusual Incident/Injury reports that were sent to CCLD- Community Care Licensing Department that C1 had a lot of Incident reports for Aggression towards other clients and staff. On 01/21/23-C1 was aggressive to staff, on 02/10/23-C1 made threats against staff, on 02/13/24-C1 was aggressive towards staff and on 02/14/24 and 04/12/24 C1 was aggressive to staff and towards another client. One (1) of the staff, confirmed that C1 hit them several times, C1 would hit themselves also and then blame staff and call the police. Three (3) out of four (4) clients confirmed that C1 was always aggressive towards staff and other clients. Let it be noted, C1 is no longer at the above facility. Therefore, based on the LPA's record reviews, staff and client interviews the above allegation(s) above is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Co-Administrator.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
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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