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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609496
Report Date: 10/24/2022
Date Signed: 10/24/2022 01:07:53 PM


Document Has Been Signed on 10/24/2022 01:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:ENCINO TERRACE SENIOR LIVINGFACILITY NUMBER:
197609496
ADMINISTRATOR:ARTEAGA, IRMAFACILITY TYPE:
740
ADDRESS:16025 VENTURA BLVDTELEPHONE:
(818) 986-8466
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY:85CENSUS: 60DATE:
10/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ivan SaaTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced Case Management visit to the facility and met with the Executive Director (ED), Ivan Saa. An incident report was received 10/18/2022 which stated that resident #1 (R1) felt that she was violated during showering. To investigate on 10/24/2022 at 10:45am, LPA interviewed the ED and on 10/24/2022 at 11:45am, LPA interviewed R1. The staff member was unavailable for questioning, but ED provided their contact information. Interviews revealed that R1 did not suspect the violation was sexual in nature, but rather the resident was allegedly being to rough during showering and wanted the caregiver to be more gentle. Interviews with the ED revealed that caregivers are on standby, hand the wash cloth to the residents and assist as needed or at the resident's request. The ED filed a police report, but after questioning R1, they decided that no crime was committed and no further investigation was required. The responsible party, R1's son, was also notified and stated that R1 has a history of telling stories and that it was more than likely not true. Since the incident, the caregiver in question no longer assists R1 with showering and the Executive Director has had in-service training for all staff regarding the matter. A file review revealed that R1 is not able to bath on their own and that R1 is a fall risk. ED also stated that they will be holding additional in-service training for staff on how to better care for their residents.

No further action at this time.

No health and safety hazards noted during the visit.

Exit interview conducted and a copy of the report was issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye DugumaTELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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