197609591-3-12-2024-28-AS-MVAO-D3XSKP-20240402135705

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609591
Report Date: 03/12/2024
Date Signed: 03/12/2024 02:12:46 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.ASC, 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
03/06/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 28-AS-20230306120009

FACILITY NAME:	T R E HOME I		FACILITY NUMBER:	197609591
ADMINISTRATOR:	JAMES CALHOUN		FACILITY TYPE:	735
ADDRESS:	1315 NORTON AVENUE		TELEPHONE:	(310) 863-4952
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91202
CAPACITY:	5	CENSUS: 3	DATE:	03/12/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	James Calhoun - Administrator		TIME COMPLETED:	02:16 PM

ALLEGATION(S):

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Staff hit resident in care

Staff pushed resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Administrator James Calhoun and explained the reason for the visit.

LPA conducted physical plant tour at 9:42 AM, requested copy of facility documents relevant to the investigation at 10:05 AM and reviewed records from 10:30 AM to 11:30 AM. LPA also interviewed staff between 11:30 AM to 1:00 PM. Regarding the allegation that the staff hit resident in care, it was alleged that Resident #1 (R1) stole a hamburger and was punished for it by Staff #1 (S1) by hitting the head of R1. LPA's interview with S1 today at 11:33 AM, revealed that R1 ate the food of Resident #2 (R2), R2 got upset and almost had an altercation with R1 but S1 redirected R2 back to own room and prepared and served R2 with another set of dinner. S1 denied hitting or even touching R1.

(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

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 28-AS-20230306120009

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: T R E HOME I	FACILITY NUMBER: 197609591
	VISIT DATE: 03/12/2024

NARRATIVE

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(continued from LIC 9099)

LPA's interview with Lanterman Regional Center (LRC) staff revealed that R1 had a history and pattern of making up story and accusing staff of hurting R1. LPA's record review today between 10:30 AM to 11:30 AM confirmed that R1 had a history of accusing staff and making up stories.

Regarding the allegation that staff pushed resident in care, it was alleged that Resident #1 (R1) stole hamburger and was punished for it by Staff #1 (S1) by pushing R1. LPA's interview with S1 today at 11:33 AM, revealed that R1 ate the food of another Resident #2 (R2) during dinner and R2 got upset and almost had an altercation with R1 but S1 intervened and redirected R2 back to own room and prepared and served R2 with another set of dinner. S1 denied pushing or even touching R1. LPA's interview with Lanterman Regional Center (LRC) staff revealed that R1 had a history and pattern of making up story and accusing staff of hurting R1. LPA's record review today between 10:30 AM to 11:30 AM confirmed that R1 had a history of accusing staff and fabricating stories.

Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC9099 (FAS) - (06/04)

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