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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609499
Report Date: 10/25/2023
Date Signed: 10/25/2023 02:49:34 PM

Substantiated


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 CENTERFACILITY NUMBER:
197609499
ADMINISTRATOR:DENZARMONE REEDFACILITY TYPE:
735
ADDRESS:20616 KITTRIDGE STREETTELEPHONE:
(818) 392-8833
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:4CENSUS: 3DATE:
10/25/2023
UNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Medina Leynes - DSPTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Facility staff are preventing resident from being able to close their bedroom door.
Facility staff are not providing a safe environment for residents.
Facility staff did not ensure that a dangerous object was locked at the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent visit to further investigate the above allegations. LPA met with staff Medina Leynes and explained the reason for the visit.

LPA conducted physical plant tour at 9:43 AM, requested copies of facility documents relevant to the investigation at 10:01 AM and interviewed staff at 10:34 AM. Regarding the allegation that the facility is not providing a safe environment for residents. It was alleged that there were nails protruding from Resident #1 (R1)'s nail flooring near bed posts posed as safety hazards. LPA Lacy's observation during visit on 02/10/23 and LPA's visit on 08/09/23 revealed that there were indeed markings of nails hammered to the floor. LPA's interview with staff and administrator though on 08/09/23 between 11:00 to 12:30 PM revealed that they tried to put nails on R1's bed posts due to R1 always jump on own bed and it constantly moves and R1 may fall from the bed, further interview also confirmed that they have removed the nail since the North Los Angeles Regional Center (NLARC) staff visit. (continued on LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
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 6
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: 10/25/2023
NARRATIVE
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(continued from LIC 9099)

Regarding the allegation that facility staff are preventing resident from being able to close their bedroom door, it was alleged that staff nailed a door stop into the flooring of R1's bedroom door to prevent R1 from closing the door and denying him his right to privacy. LPA Lacy's observation during visit on 02/10/23, revealed that there was indeed marking on the floor where staff nailed a door stopper on R1's room. LPA's observation during visit on 08/09/23 also revealed the same. LPA's interview with administrator and staff on 08/09/23 between 11:00 AM to 12:30 PM confirmed that staff indeed put a door stopper to R1's room but not to deprive R1 of privacy but due to R1's behavior during early mornings wherein R1 kept on banging own door multiple times every day waking up other residents of the facility. Further interview with the administrator and LPA's observation confirmed that the facility has since removed the door stopper.

Regarding the allegation that facility staff did not ensure that a dangerous object was locked at the facility, it was alleged that there was a heavy large hammer inside an unlocked kitchen cabinet found by a credible witness. LPA Lacy's observation during visit on 02/10/23, revealed that there was no unlocked hammer, or any sharp object was found during visit, same thing was observed by the LPA during visit on 08/09/23.

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

Citation issued. Appeal rights discussed and given. Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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: 10/25/2023
NARRATIVE
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(continued from LIC 9099)
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2023
Section Cited
CCR
80087(g)
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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 is not met as evidenced by:
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Cleared during visit. Staff had already removed and kept the hammer during credible witness's visit.
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Based on credible witness' observation, the facility failed to ensure that a dangerous object was kept inaccessible to residents. This poses an immediate health and safety risk to the residents in care.
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Type A
10/25/2023
Section Cited
HSC
80072(a)(2)
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To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement is not met as evidenced by:
Based on credible witness's and LPAs' observation, Licensee failed to ensure that
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Cleared during visit. The door stopper and nails were all removed during the credible witness's visit.
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the clients are free from harm where protruding nails and door stopper was observed to be nailed on the floor of R1's room. This poses an immediate health and safety risks to the residents 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: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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 CENTERFACILITY NUMBER:
197609499
ADMINISTRATOR:DENZARMONE REEDFACILITY TYPE:
735
ADDRESS:20616 KITTRIDGE STREETTELEPHONE:
(818) 392-8833
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:4CENSUS: 3DATE:
10/25/2023
UNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Medina Leynes - DSPTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
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5
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9
Facility is in disrepair

Facility staff are not ensuring that trash is removed from the property.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent visit to further investigate the above allegations. LPA met with staff Medina Leynes and explained the reason for the visit.

LPA conducted physical plant tour at 9:43 AM, requested copies of facility documents relevant to the investigation at 10:01 AM and interviewed staff at 10:34 AM. Regarding the allegation that the facility is in disrepair, it was alleged that there were broken boards alongside the exterior rear and the back fencing is falling in disrepair. LPA's observation during prior visit on 08/09/23 at around 10:30 AM revealed that there was no wall or broken boards outside or inside the facility. LPA's interview with the administrator on 08/09/23 between 11:00 AM to 12:30 PM revealed that during the credible witness's visit was during the heavy rainy season this year and that there was no activity being held at the backyard as it was still raining heavy at this time. Further, the fence was not in disrepair, it was moved due to flooding and strong winds and the broken boards are not part of the walls or fence, it just so happened that it was stocked at the area and staff were not able to move it due to heavy rains. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
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: 10/25/2023
NARRATIVE
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(continued from LIC 9099)

Regarding the allegation that the facility staff are not ensuring that trash is removed from the property, it was alleged that there are trash items outside the property. LPA's observation during visit on 08/09/23, LPA did not observe any trash inside or outside of the facility. LPA's interview with staff and administrator on 08/09/23 between 11:00 AM and 2:30 PM revealed that there was a scheduled trash pick-up in the address just like everywhere else in the city and it was days before the pickup when the credible witness observed the trash in the backyard area.

Based on the information gathered during this and prior visit, these allegations were 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: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6