197609554-12-16-2021-31-AS-NGID-CCLUKC-20220317153855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609554
Report Date: 12/16/2021
Date Signed: 12/16/2021 12:48:34 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
12/08/2021 and conducted by Evaluator Shira Stamps

COMPLAINT CONTROL NUMBER: 31-AS-20211208092838

FACILITY NAME:	SUNSHINE RESIDENTIAL HOME WOODLEY		FACILITY NUMBER:	197609554
ADMINISTRATOR:	JOSE, OYINLOYE AUSTINE		FACILITY TYPE:	735
ADDRESS:	10534 WOODLEY AVENUE		TELEPHONE:	(818) 274-1809
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	4	CENSUS:	DATE:	12/16/2021
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Charity Joseph, Caregiver		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident was threatened while in care.

Resident was spoken to inappropriately while in care.

INVESTIGATION FINDINGS:

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At 10:25am Licensing Program Analyst (LPA) Shira Stamps arrived at the facility mentioned above for an initial complaint visit. The LPA was greeted at the door by caregiver, Charity Joseph. The LPA spoke to the Administrator over the phone at 10:27am, and provided LPA’s email address for documents to be sent. Entrance interview conducted over the phone.

At approximately 10:40 am, LPA conducted a physical plant walk through, and LPA did not observe any immediate health and safety issues during this visit. From 10:50am-11:16am, LPA conducted interviews with three (3) staff members, three (3) residents, and one (1) outside agency staff member.

Allegation: Resident was threatened while in care.

Interviews with two (2) out of three (3) staff members stated they have never seen or heard a staff member threaten a resident. Continued.....

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

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-20211208092838

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: SUNSHINE RESIDENTIAL HOME WOODLEY	FACILITY NUMBER: 197609554
	VISIT DATE: 12/16/2021

NARRATIVE

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One (1) out of three (3) staff members stated they were informed of a staff member verbally threatening a resident while in care. One (1) out of four (4) residents stated they have never been threatened by a staff member or seen a staff member threaten other residents. One (1) out of three (3) residents stated a staff member has verbally threatened them while in care. Two (2) out of four (4) residents are non-verbal and were unable to be interviewed. The LPA observed documents provided by the Administrator that shows the staff member in question was terminated due to disrespectful communication and unprofessional behavior with a resident in care. Therefore, after review of the information received and the interviews conducted the allegation, “Resident was threatened while in care.,” is deemed substantiated.

Allegation: Resident was spoken to inappropriately while in care.

Interviews with two (2) out of three (3) staff members stated they have never seen a staff member speak inappropriately to a resident in care. One (1) out of three (3) staff members stated they were informed of a staff member speaking inappropriately to a resident. Interviews with One (1) out of four (4) residents stated staff have never spoken to residents inappropriately. Two (2) out of four (4) residents are non-verbal and were unable to be interviewed. One (1) out of four (4) staff members stated a staff member has spoken to them inappropriately. The LPA observed documents provided by the Administrator that shows the staff member in question was terminated due to disrespectful communication and unprofessional behavior with a resident in care. Therefore, after review of the information received and interviews conducted the allegation, “Resident was spoken to inappropriately while in care,” is deemed substantiated.

Exit interview conducted. Report delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20211208092838

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: SUNSHINE RESIDENTIAL HOME WOODLEY	FACILITY NUMBER: 197609554
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/16/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/27/2021 Section Cited CCR 80072(a)(3)	1 2 3 4 5 6 7	80072(a)(3) Personal Rights...(a) each client shall have personal rights (3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental.. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Administrator has agreed to provide personal rights training to all staff members. Because this incident took place on 12/02/21, the Administrator immediately provided personal rights training to all staff members, and a copy of the training was provided during the visit.
	8 9 10 11 12 13 14	Based on the investigation, A resident was threatened verbally by a staff member, which poses a potential risk to residents in care.	8 9 10 11 12 13 14
Type B 12/27/2021 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1(a)(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator has agreed to provide personal rights training to all staff members. Because this incident took place on 12/02/21, the Administrator immediately provided personal rights training to all staff members, and a copy of the training was provided during the visit.
	8 9 10 11 12 13 14	Based on interviews and documents received; the staff failed to communicate appropriately with residents in care, which poses a potential risk to residents.	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: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

LIC9099 (FAS) - (06/04)

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