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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609499
Report Date: 02/10/2023
Date Signed: 02/10/2023 03:26:26 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
02/03/2023 and conducted by Evaluator LaQueena Lacy
COMPLAINT CONTROL NUMBER: 31-AS-20230203101904
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:
02/10/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Medina LeynesTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility staff left medication accessible to clients.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) LaQueena Lacy conducted an unannounced initial 10day complaint visit on 02/10/2023 at 10:45am. LPA met with the Direct Support Professional Medina Leynes and explained the purpose of the visit.

LPA conducted a physical plant tour at 11:00am. LPA requested and obtained copies of documents relevant to the investigation at 11:38am.

It is alleged that staff #1 (S1) left a bag of their prescribed medications on top of a dresser in bedroom #2 accessible to clients. To investigate the above allegation, LPA interviewed the Administrator and staff at approximately 11:46am. During the investigation S2 admitted that they were running late for an appointment and left their prescribed medication in vacant bedroom #2 and that clients never go in that bedroom. The administrator confirmed that S2 left their medication by accident due to running late for an appointment.
Continued on LIC9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
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 4
Control Number 31-AS-20230203101904
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: 02/10/2023
NARRATIVE
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Upon inspection of three (03) out of four (04) client bedrooms, LPA observed bedroom #2 to be vacant and not occupying any client personal items and to be unlocked and accessible to clients in care. Based on the information obtained through observation, and interviews it was concluded that S2 left their medication accessible to clients in care, Therefore the above allegation is SUBSTANTIATED.

Deficiencies cited on 9099D, exit interview conducted, copy of report and appeal rights issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20230203101904
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: 02/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2023
Section Cited
CCR
80075(k)(1)
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80075 Health Related Services(k)The following requirements shall apply to medications which are centrally stored(1) Medication shall be kept in a safe and locked place that is not accessible to persons... This requirement was not met as evidenced by:
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Licensee will conduct an inservice training on medication by an authorized vendor or medical professional. Licensee will submit to LPA by email by POC due date of the scheduled training date or completion.
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Based on interviews with the administrator and S2, S2 failed to retain their personal medication and ensure that they were inaccessible to clients in care, this poses a potential health and saftey and personal rights risk to persons 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: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4