197609499-6-10-2024-31-AS-NGID-D68VM7-20240614163303

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609499
Report Date: 06/10/2024
Date Signed: 06/10/2024 12:04:04 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.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
12/05/2023 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20231205151542

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: 3	DATE:	06/10/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Armando Oliveros, Staff		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility staff poked resident with an object.
Facility staff spoke inappropriately to resident.

INVESTIGATION FINDINGS:

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At 09:45 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent complaint visit. LPA met with staff, Armando Oliveros, and Administrator was contacted via telephone. LPA explained the reason for the visit. Administrator was not be able to come and designated staff to sign the report. LPA conducted a physical plant tour of the facility with staff.

On 12/13/2023, Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced initial complaint visit to the facility to investigate the allegations above. LPA Agban requested clients and staff roster. At approximately 11:00 AM, LPA Agban requested copies of pertinent information which include, but not limited to Physician’s Report, Admission Agreement, Appraisal Needs and Services Plan, etc., relevant to the investigation. Between 11:00 AM – 12:00 PM, LPA Agban conducted interviews with the Administrator, Two (2) staff and One (1) Client. Additionally, on 02/21/2024, LPA Agban and LPA Nicolas Reed conducted a collateral visit at The Adult Skills Center to interview Client 1 (C1).
Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024

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-20231205151542

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: 06/10/2024

NARRATIVE

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Facility staff poked resident with an object:

It was alleged that the Administrator poked the client with a fork while in care. During the initial visit conducted by LPA Agban, interview with the Administrator revealed that the incident never occurred and the Administrator denied the allegation. Furthermore, during the initial visit conducted by LPA Agban interview with C3 confirmed that no staff members ever poked or touched C1 with any object. C3 also informed LPA Agban that they did not witness any incidents with C1. However, C3 did witness C1 having behavioral issues. Based on the interviews during the initial visit, this allegation is Unsubstantiated at this time.

Facility staff spoke inappropriately to resident:
It was alleged that facility staff spoke inappropriately to C1. During the Initial complaint visit conducted by LPA Agban on 12/13/2023, interviews with the Administrator, two (2) staff, and one (1) client (C3), revealed that facility staff did not speak inappropriately to any of the clients, and they have not witnessed staff speaking inappropriately to C1. Interview with C3 also confirmed that C1 gets agitated easily and their behavior gets out of control; however, the facility staff is well trained on how to redirect clients and clam them down. Based on the interviews conducted by LPA Agban, there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024

LIC9099 (FAS) - (06/04)

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