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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609499
Report Date: 09/24/2021
Date Signed: 09/24/2021 02:16:56 PM

Substantiated


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
09/21/2021 and conducted by Evaluator Wendell Smith
COMPLAINT CONTROL NUMBER: 31-AS-20210921143255
FACILITY NAME:PRIME CHOICE HOME CENTERFACILITY NUMBER:
197609499
ADMINISTRATOR:DENZARMONE REEDFACILITY TYPE:
735
ADDRESS:20616 KITTRIDGE STREETTELEPHONE:
(818) 392-8833
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:4CENSUS: 3DATE:
09/24/2021
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Denzarmone ReedTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff members slept overnight in a common area of the facility.
Staff are not following COVID-19 guidelines.
Cleaning supplies were found in an unlocked cabinet.
Facility is in disrepair
Facility food supply is inadequate.
Staff lack current training.
Facility does not have access to the garage.
INVESTIGATION FINDINGS:
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Licensing Program Analyst(s) Wendell Smith and Calvin Tsui conducted an unannounced complaint visit to this facility. LPA's met with the house manager and explained the reason for this visit. From 9:00am through 9:15am a physical plant tour was conducted of the facility.

Staff member slept overnight in a common area of the facility.
It is alleged that staff members have slept in the living room and in the garage area of this facility. On a visit conducted by North Los Angeles Regional Center (NLRC) on 9/15/21 some of this was observed. During today's visit LPA's conducted interviews clients and facility staff from approximately 9:15-:9:45 regarding this allegation. Interviews revealed that staff have slept on the couch in the living room and that staff have slept in the garage when not on shift at the facility. Based upon the information obtained through interviews this allegation is deemed Substantiated. Deficiency cited on LIC 9099 D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
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 7
Control Number 31-AS-20210921143255
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: PRIME CHOICE HOME CENTER
FACILITY NUMBER: 197609499
VISIT DATE: 09/24/2021
NARRATIVE
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Staff are not following COVID-19 guidelines.
It is alleged that on a visit by NLRC it was observed that facility staff were not wearing mask and were not checking visitors temperatures when they entered the facility. LPA's conducted interviews with staff regarding this allegation from 9:15-9:45am. Information obtained from interviews revealed that since all staff were vaccinated they did not think they needed to wear mask anymore and that they did not check the temperatures of some visitors when they entered the facility. When LPA's entered the facility today LPA's temperatures were taken by facility staff upon entry. Based on the information obtained through interviews this allegation is deemed Substantiated at this time. Deficiency cited on LIC 9099 D.

Cleaning supplies were found in an unlocked cabinet & Facility is in disrepair.
It is alleged that during a visit with NLRC on 9/15/21 that cleaning supplies were found in an unlocked cabinet and that the facility was observed to have rotten wood gutters and old doors sitting on the side of the facility. It was also observed that the facility had old appliances in the backyard such as a washing machine that was not operating. During the physical plant tour which was conducted from 9:00 am through 9:15am LPA's observed the rotten wood gutters. During interviews with facility staff it was found that they did have old washing machine that was not operating along with an old door sitting on the side of the facility. Staff stated they called the City of Los Angeles to pick up the old washer and the door. During the walk through LPA's did not observed the old washer and the old door. Based on the information obtained through interviews both of these allegations are deemed Substantiated. Deficiencies cited on LIC 9099 D.

Facility food supply is inadequate.
It is alleged that during a visit with NLRC on 9/15/21 that the food supply was found to be inadequate. It was observed that the food supply was observed to be low for the clients and staff at the facility. During today's visit LPA's checked the facility's food supply and observed there to be a sufficient amount of perishable and non perishable food. During an interview with facility staff they admitted that they had not gone shopping for the week. Based on the information obtained during interviews this allegation is deemed Substantiated. Deficiency cited on LIC 9099 D.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 31-AS-20210921143255
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: PRIME CHOICE HOME CENTER
FACILITY NUMBER: 197609499
VISIT DATE: 09/24/2021
NARRATIVE
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Staff lack current training.
It is alleged that during a visit with NLRC on 9/15/21 that current facility staff did not have up to date Crisis Prevention Intervention (CPI) training and that it had expired. LPA's conducted a file review of staff files from 10am-10:20am and observed that staff just had their CPI training done on 9/21/21 and that on 9/15/21 their CPI certificates had already expired. Based on interviews and observation this allegation is deemed Substantiated. Deficiency cited on LIC 9099 D. Appeal Rights explained.

Facility does not have access to the garage.
It is alleged that during a visit with NLRC on 9/15/21 facility staff did not have access to the garage due to not having a key. During the physical plant walk through from 9:15-9:45 am LPA's also could not access the garage due to staff stating they did not have a key. Facility staff stated that they have not had access to the garage for three weeks due to a staff member taking the key and it having not been returned as of yet. Based on the information obtained this allegation is deemed Substantiated at this time. The garage is part of the facility as needs to be accessible to be inspected by licensing as well as NLRC. Deficiency cited on LIC 9099D. Appeal Rights explained. Exit Interview conducted.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 31-AS-20210921143255
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: PRIME CHOICE HOME CENTER
FACILITY NUMBER: 197609499
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2021
Section Cited
CCR
80072(a)(2)
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Personal Rights-To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
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Administrator shall submit an in-service with staff regarding the importance of wearing mask at all times when in the facility and checking every visitor's temperature before they enter the facility.
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Based on interviews conducted facility staff were not wearing mask or checking visitors for temperatures which poses an immediate health and safety risk for clients in the facility.
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Type A
09/24/2021
Section Cited
CCR
80087(g)
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Buildings and Grounds-Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement was not met as evidenced by:
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Corrected before visit. Cleaning supplies were locked up immediately.
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Based on interviews conducted on 9/15/21 cleaning supplies were found unlocked in a closet accessible to clients. This poses an immediate health and safety risk to clients 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.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 31-AS-20210921143255
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: PRIME CHOICE HOME CENTER
FACILITY NUMBER: 197609499
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2021
Section Cited
CCR
80087(a)
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Buildings and Grounds-The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
This requirement was not met as evidenced by:
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Administrator shall submit plan on how to address wood gutters that are rotting by poc due date. The old washer and door have already been removed.
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Based on observation and interviews it was observed that wood gutters were rotting and facility had an old washer and door sitting in the backyard on the side of the facility. This could pose a health and safety risk to clients in care.
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Type B
09/27/2021
Section Cited
CCR
80087(a)(3)(A)
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Buildings and Grounds-No room commonly used for other purposes shall be used as a bedroom for any person.Such rooms shall include but not be limited to halls, stairways, unfinished attics or basements, garages, storage areas. This requirement was not met as evidenced by:
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Administrator shall have staff in-service training on not sleeping in common areas and not sleeping in the garage. Copy of the in-service shall be sent to LPA.
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Based on interviews conducted it was found that facility staff have been sleeping on the couch in the living room and in the garage when not on shift. This poses a health and safety risk to clients 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.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 31-AS-20210921143255
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: PRIME CHOICE HOME CENTER
FACILITY NUMBER: 197609499
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2021
Section Cited
CCR
80065(a)
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Personnel Requirements-Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement was not met as evidenced by
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Administrator shall submit a plan on how staff will have access to the garage of the facility and how it will be accessible for inspection by licensing and NLRC.
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Based on observation and interviews facility staff claims they do not have access to the garage and hasn't had access for over two weeks. This could pose a health and safety risk to clients in the facility.
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Type B
09/24/2021
Section Cited
CCR
85076
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Food Service-Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days shall be maintained on the premises.
This requirement was not met as evidenced by:
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Corrected before visit. LPA's observed a sufficient amount of perishable and non perishable food. Administrator will submit statement that shopping will be done on an earlier basis so the minimum amount of food allowed by licensing will always be ready in the facility.
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Based on interviews conducted it was observed on 9/15/21 facility did not have enough perishable foods in the facility due to not having gone food shopping that week yet. This posed a potential health and safety risk to the clients 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.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 31-AS-20210921143255
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: PRIME CHOICE HOME CENTER
FACILITY NUMBER: 197609499
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/24/2021
Section Cited
CCR
80064(a)(4)
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Administrator Qualifications-Ability to maintain or supervise the maintenance of financial and other records.
This requirement was not met as evidenced by:
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Corrected before visit. On 9/21/21 staff had their CPI training completed.
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Based on record review facility staff's crisis prevention intervention(CPI) training which is required had expired which poses a potential health and safety risk to clients 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.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
LIC9099 (FAS) - (06/04)
Page: 7 of 7