<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609499
Report Date: 03/04/2024
Date Signed: 03/04/2024 12:46:54 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.RO, 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
02/28/2024 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20240228154113
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:
03/04/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Elizabeth WilsonTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure facility is free of pests.
Staff do not ensure facility physical plant is safe, sanitary and in good repair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Lorena Casillas arrived at the facility to conduct an unannounced complaint visit on the above allegations. At 10:15 AM LPA met with House Manager Armando Oliveros who called Administrator Elizabeth Wilson. LPA Casillas spoke to Administrator and was advised that they would not be able to come to the facility as they were feeling under the weather. Administrator assigned House Manager as designated employee to sign the report. LPA then explained the reason for the visit.

At 10:50 AM LPA Casillas conducted a physical plant tour. During the investigation, interviews and record reviews were made. LPA requested resident roster, Bond Insurance, Liability Insurance and LIC 500. LPA requested copies of information pertaining to the investigation including but not limited to pest control receipts and any other documents relevant to the investigation. There were two clients in the home and one client was at day program. LPA conducted interviews with two (2) of the three (3) clients as well as House Manager and staff #1 (S1).
Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
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 5
Control Number 31-AS-20240228154113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PRIME CHOICE HOME CENTER
FACILITY NUMBER: 197609499
VISIT DATE: 03/04/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation #1: Staff do not ensure facility is free of pests.

Regarding this allegation, it was alleged that client rooms and dressers had bugs. During the physical plant tour, LPA did observe dead and live cockroaches in the rooms. During interviews with staff, staff stated that the facility does have a cockroach problem in a particular room, however LPA observed dead bugs in other rooms. During interviews with clients, two (2) out of three (3) clients stated that they have witnessed cockroaches and other pests in the facility. Based on interviews and observations, there is sufficient information to support the allegation. Therefore, the allegation is SUBSTANTIATED at this time.



Allegation #4: Staff do not ensure facility physical plant is safe, sanitary and in good repair.

Regarding this allegation, it is alleged that the floor is unclean, unsanitary and in disrepair. During the physical plant tour LPA observed the floor to be clean, however an occupied room had floor planks that are tearing and in disrepair. When LPA asked House Manager about the floor there was no explanation given. Based on observations and interviews it is determined that this allegation is deemed SUBSTANTIATED.

Refer to LIC 9099-D

Exit Interview conducted. Citation issued. Appeals rights discussed and copy of report given to House Manager.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20240228154113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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: 03/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/08/2024
Section Cited
CCR
80087(a)(1)
1
2
3
4
5
6
7
80087(a)(1) Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times…(1) The licensee shall take measures to keep the facility free of flies and other insects. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Administrator will contract a pest control company to maintain the facility once a month for the next three (3) months. Administrator will email LPA a copy of receipt where maintenance will be outlined. The receipt for first visit will be submitted to LPA via email by 03/08/2024.
8
9
10
11
12
13
14
Based on interviews and observations, the Administrator failed to ensure that the facility was free from insects and pests, this poses an immediate health and safety and personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
03/15/2024
Section Cited
CCR
80087(a)
1
2
3
4
5
6
7
80087(a) Buildings and Grounds (a) 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 evidence by:
1
2
3
4
5
6
7
Administrator will contact a handy man or contractor to get a repair plan going and will submit to LPA via email by POC due date. Furthermore, Administrator will email LPA pictures of clean areas and will email copy of receipt for repairs.
8
9
10
11
12
13
14
Based on interviews and observations, Administrator has not replaced torn floor planks, this poses an immediate health and safety and personal rights risk to persons in care.
8
9
10
11
12
13
14
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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
02/28/2024 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20240228154113

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:
03/04/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Elizabeth WilsonTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure facility has sufficient food supply.
Staff do not ensure proper disposal of contaminated and/or spoiled food.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Lorena Casillas arrived at the facility to conduct an unannounced complaint visit on the above allegations. At 10:15 AM LPA met with House Manager Armando Oliveros who called Administrator Elizabeth Wilson. LPA Casillas spoke to Administrator and was advised that they would not be able to come to the facility as they were feeling under the weather. Administrator assigned House Manager as designated employee to sign the report. LPA then explained the reason for the visit.

At 10:50 AM LPA Casillas conducted a physical plant tour. During the investigation, interviews and record reviews were made. LPA requested resident roster, Bond Insurance, Liability Insurance and LIC 500. LPA requested copies of information pertaining to the investigation including but not limited to pest control receipts and any other documents relevant to the investigation. There were two clients in the home and one client was at day program. LPA conducted interviews with two (2) of the three (3) clients as well as House Manager and staff #1 (S1).
Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20240228154113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PRIME CHOICE HOME CENTER
FACILITY NUMBER: 197609499
VISIT DATE: 03/04/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation #2: Staff do not ensure facility has sufficient food supply.
Regarding this allegation, it is alleged that there is not enough food for clients. During the physical plant tour LPA observed that there was two (2) days’ worth of perishable food and seven (7) days’ worth of non-perishable food. Furthermore, interviews with two (2) out of three (3) clients and two (2) out of two (2) staff confirmed that there is enough food for clients in care, therefore this allegation is deemed UNSUBSTANTIATED.

Allegation #3: Staff do not ensure proper disposal of contaminated and/or spoiled food.
Regarding this allegation, it is alleged that staff do not ensure proper disposal of contaminated and/or spoiled food. During the physical plant tour LPA observed trash cans with lids throughout the facility. LPA did not observe any food to be spoiled or not edible. Interview with clients revealed that food that is served is in good condition and tastes good. Interview with staff revealed that food that is cooked is fresh and in good condition, furthermore any food that is not consumed and is not saved, is thrown away. Based on observations and interviews it is determined that this allegation is deemed UNSUBSTANTIATED.

Exit Interview conducted and a copy of this report given to House Manager.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5