197609499-1-29-2025-31-AS-NGID-DF5N58-20250326100903

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609499
Report Date: 01/29/2025
Date Signed: 01/29/2025 02:12:10 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
01/23/2025 and conducted by Evaluator Perchui Khurshudyan

COMPLAINT CONTROL NUMBER: 31-AS-20250123150415

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:	01/29/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Odet Leyles - Caregiver		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not prevent a client from attacking another client while in care

INVESTIGATION FINDINGS:

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On 1/29/25 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an innitial 10 day complaint visit at this facility to investigate above allegation. Upon arrival, LPA met with the Caregiver Medina Odet Leynes and introduced herself by showing the badge. LPA explained the reson for the visit and conducted entrance interview.

At approximately 10:00am LPA requested staff and residnet rosters, documents relevant to the investigation which include, but not limited to facility Policy and Procedures, copies of Unusual Incident Reports.
LPA with the help of Caregiver conducted a physical plant tour between 10:30am to 10:45am to ensure health and safety of the residents are protected. No health and safety hazards noted during the visit.

During course of investigation, LPA interviewed two (2) clients, three (3) staff members, and conducted records review.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

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-20250123150415

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: 01/29/2025

NARRATIVE

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Allegation: Staff did not prevent a client from attacking another client while in care.

It was reported that C2 physically assaulted C1 by striking her/him on the face for a total of 5 times and staff did not prevent from happening. To investigate this allegation LPA interviewed three (3) staff members. Staff interviews indicated that sometimes clients have verbal arguments, but they never witnessed any client get physical and abuse another client in care. Staff members also stated that C1 had emotional and behavioral breakdown at the facility and at the day program and was referred to see medical professional for evaluation. There is no reports of current or past visible marks noticed from the home or Day Program staff. C1 got admitted to Woodland Hills Kaiser hospital on 1/22 for further psychiatric observation evaluation and got discharged on 1/24 with medication orders prescribed by the evaluating doctor. LPA reviewed the incident reports sent to Community Care Licensing on 1/22/25 indicating that C1 expressed threats of harming himself/herself and C2 after accusing C2 deleting his/her girlfriend’s number whom he/she found online. From 12:00pm-12:45pm, LPA interviewed two (2) out of three (3) clients. Interview with C2 declined having any physical arguments with C1, C2 also added that sometimes they both get into verbal arguments for not having similar visions but C2 will never touch physically to anyone. Staff and Client interviews indicated C1 has history of hallucinations and makes up different stories which are not real. Interview with C1 revealed that C1 believes C2 has very close connections with “underworld” and by taking $45 from him/her made an investment with world market, however, later changed the story and stated that C1 only gave food money to C2 to buy food for him/her. LPA observed C1 has lock on his/her bedroom which was installed recently by the staff of the facility. Reviewing records, LPA observed all staff members have required training and are well aware of how to handle behavioral scenarios. Based on interviews and record review, there is insufficient evidence to prove the alleged violation did occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided. Appeal rights discussed.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

LIC9099 (FAS) - (06/04)

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