197609554-9-20-2023-31-AS-MVAO-CWSQQ3-20231020122139

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609554
Report Date: 09/20/2023
Date Signed: 09/20/2023 12:47:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
09/11/2023 and conducted by Evaluator Evelin Rios

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230911091948

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: 4	DATE:	09/20/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Rebecca Westbrook / Administrator Designee		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff hit resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Evelin Rios conducted a complaint visit to the facility to investigate the above allegation. It was reported that Resident #1 (R1) was hit by staff. LPA met with the Administrator Designee Rebecca Westbrook. Licensee Jose Oyinloye Austine met LPA shortly after. Administrator Designee and Licensee were advised of the complaint.

Today's investigation consisted of a physical plant tour to ensure the health and safety of the residents in care, staff and resident interviews and a review of facility records.

According to the Licensee and Administrator, R1 is prone to wondering and has had previous incidents of calling 911 to be taken to the hospital. Conversations between Licensee, Department of Mental Health and R1's conservator indicate it has been an ongoing occurance. R1's Individual Program Plan (IPP) from 09/17/2020 reports, R1 requires supervision and is prone to challenging behaviors with previous hospitalization documented. (LIC9099-C Continued on to next page)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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-20230911091948

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNSHINE RESIDENTIAL HOME WOODLEY	FACILITY NUMBER: 197609554
	VISIT DATE: 09/20/2023

NARRATIVE

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At approximately 9:45 a.m. LPA interviewed R1, R1 denied the allegation "staff hit resident" around the time the allegation was made. R1 however confirms staff hit them two days ago while R1 was outside in the community because they did not want to return to the facility. At approximately 10:15 a.m. LPA interview with staff #1 (S1), S1 denied the allegation. As for the incident two days ago according to S1, while R1 was attempting to cross the street on a red light S1 grabbed R1 by the back part of R1's pants to pull them back to the sidewalk. S1 states R1 then fell back and started accusing S1 of hitting them. Interviews with staff corroborate R1 was wondering on Monday evening and S1 was with them but they did not witness the incident.

Interviews with four (4) out of four (4) staff present all denied the allegation. Staff interviews revealed R1 is free to leave the facility with their 1 on 1. According to staff interviews R1 will say they want out of the facility and to call 911 to be taken to the hospital. Staff all corroborate S1 will call 911 and be taken to the hospital and return back to the facility. LPA attempted to interview all other residents present in the facility but one (1) resident was napping and the other two (2) residents did not respond to LPA's questioning.

Based on the information obtained, it could not be proven that staff hit resident. Therefore the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of this report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC9099 (FAS) - (06/04)

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