197609499-8-9-2023-31-AS-TAGD-CZLSVK-20240118131246

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609499
Report Date: 08/09/2023
Date Signed: 08/09/2023 02:20:41 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.ASC, 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 Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230203101904

FACILITY NAME:	PRIME CHOICE HOME CENTER		FACILITY NUMBER:	197609499
ADMINISTRATOR:	DENZARMONE REED		FACILITY TYPE:	735
ADDRESS:	20616 KITTRIDGE STREET		TELEPHONE:	(818) 392-8833
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY:	4	CENSUS: 4	DATE:	08/09/2023
		UNANNOUNCED	TIME BEGAN:	09:54 AM
MET WITH:	Elizabeth Wilson - Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility staff are not ensuring that resident is afforded privacy while showering

Facility staff are not ensuring that facility has an adequate supply of perishable foods

Facility staff are not ensuring that outside social activity provides shade for the residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent visit at this facility to further investigate the above allegations. LPA met with Administrator Elizabeth Wilson and explained the reason for the visit.

LPA conducted physical plant tour at 10:10 AM, requested copies of facility documents relevant to the investigation at 11:00 AM and interviewed the administrator and staff between 11:00 AM to 12:30 PM. Regarding the allegation that Facility staff are not ensuring that resident is afforded privacy while showering, it was alleged that Resident #1 (R1)'s bathroom shower window was not obscured and offers no privacy to R1. LPA's observation during physical plant tour inside and out at 10:10 AM revealed that the shower of R1 has about four (4") feet of wall before the window and covers the entire body of a person showering and the window had a translucent glass and a screen in between and if closed, nothing is visible inside from looking at the outside of the window. (continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: PRIME CHOICE HOME CENTER	FACILITY NUMBER: 197609499
	VISIT DATE: 08/09/2023

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that Facility staff are not ensuring that facility has an adequate supply of perishable foods, it was alleged that the facility needed an immediate replenishment of perishable food. LPA's observation during visit revealed that the facility has sufficient perishable and non-perishable food in stock. LPA's interview with the administrator revealed that she was not aware nor were told what perishable food they were lacking or missing because they have an extra freezer of frozen foods and always have stock of milk and fruits at the facility at anytime. Further, LPA's interview with staff confirmed that they never ran out of food at the facility and they do their grocery shopping on a weekly basis.

Regarding the allegation that the Facility staff are not ensuring that outside social activity provides shade for the residents, LPA observation during physical plant tour revealed that the facility has a shaded area with furniture. LPA interview with the administrator today at 11:00 AM revealed that during the heavy rainy season this year, winds and rain broke the shade at the backyard and it was still raining so there was no activity outside during these times but once it stopped raining they immediately replaced the shade at the backyard.

Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC9099 (FAS) - (06/04)

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