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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609544
Report Date: 10/21/2022
Date Signed: 10/21/2022 05:54:54 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/10/2022 and conducted by Evaluator Wendell Smith
COMPLAINT CONTROL NUMBER: 31-AS-20221010150155
FACILITY NAME:EPT BETTER LIVINGFACILITY NUMBER:
197609544
ADMINISTRATOR:TABACH, ELENAFACILITY TYPE:
735
ADDRESS:18217 WELBY WAYTELEPHONE:
(818) 457-4199
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:4CENSUS: 4DATE:
10/21/2022
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Proserfina Espiritu TIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff hit resident with an object
Staff handled resident in a rough manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to finish investigation into the allegations above. LPA met with facility staff and explained the reason for this visit.
Regarding the allegations above it is alleged that staff #1 (S1) hit client#1 (C1) with a broom and handled C1 in a rough manner during an incident on 9/14/22. LPA conducted previous visits on 10/11/22 and 10/17/22. During those visits LPA interviewed facility staff and clients. During today's visit LPA conducted interviews with clients and staff from 4-4:30pm. LPA spoke with S1 by telephone regarding the allegations. Information obtained through interviews with clients and staff revealed that on 9/14/22 during an incident in the morning S1 was observed by two witnesses hitting C1 with a broom and handling C1 in a rough manner. Interviews conducted reveal that there were no injuries caused by the hit to C1. Based on the information obtained through interviews both of these allegations are deemed Substantiated. Deficiency cited on LIC 9099 D. Appeal Rights explained. Exit Interview conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
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 2
Control Number 31-AS-20221010150155
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: EPT BETTER LIVING
FACILITY NUMBER: 197609544
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/24/2022
Section Cited
CCR
87468.(a)(1)
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Personal Rights:Residents in all residential care facilities for the elderly shall have all of the following personal rights-To be accorded dignity in their personal relationships with staff, residents, and other persons.
This requirement was not met as evidenced by:
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S1 has been removed from the facility and is currently not working in the facility. Administrator will send LPA more definite plan with regards to S1 by poc due date.
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Based on interviews conducted it was found that S1 hit C1 with a broom in the facial area and handled C1 roughly which posed an immediate health and safety risk to all 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: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2