197609591-9-9-2025-31-AS-NMAN-DLTVSE-20250924164122

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609591
Report Date: 09/09/2025
Date Signed: 09/09/2025 03:24:45 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
09/03/2025 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20250903115743

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: 4	DATE:	09/09/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	James Calhoun, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Resident was phyically assalted by staff.

INVESTIGATION FINDINGS:

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At 10:00 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced initial complaint visit. LPA met with staff, Keyrhon King, and Administrator was contacted via telephone. The Administrator arrived at 11:45 AM and LPA explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 10:10 AM, LPA requested client and staff roster. At approximately 10:15 AM, LPA conducted a physical plant tour. At 11:50 AM, LPA requested copies of pertinent information which include, but not limited to Physician Report, Admission Agreement, Appraisal Needs and Service Plan, Staff training, etc., relevant to the investigation. Between 10:20 AM – 2:30 PM, LPA conducted an interview with the Administrator , two (2) staff, a Registered Nurse (RN), and four (4) out of four (4) clients.
Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

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-20250903115743

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: T R E HOME I	FACILITY NUMBER: 197609591
	VISIT DATE: 09/09/2025

NARRATIVE

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Resident was physically assaulted by staff.
It was alleged that the staff #1 (S1) kicked Client #1 (C1) in the hall way. To investigate this allegation LPA conducted an interview with the Administrator and Staff #1 (S1) and both parties denied the above allegation and informed LPA that on 09/02/2025 at around 9:30 AM, C1 had a behavior episode and C1 broke the Television and a coffee table. The staff redirected C1, and continued to monitor C1 every fifteen minutes; however, C1 managed to elope the facility through neighbor's fence. Upon discovery the staff immediately contacted 9-1-1 to report the incident. When C1 was located by the police, C1 was admitted to the hospital for further assessment. During today's visit, LPA conducted a collateral visit to Adventist Health Glendale hospital to interview C1. LPA was informed by the RN that C1 is currently at Psychiatric Department. Interview with the RN also revealed that a complete assessment of C1 was conducted upon admission and no signs of physical assault were noted. Additionally, LPA was informed that C1 was admitted to the hospital due to hearing voices. Interview with C1 confirmed that on 09/02/2025, C1 had psychosis and was hearing voices. Lastly, interview with three (3) clients revealed that no physical assault took place nor any witnesses were available to confirm. Therefore, based on interviews, record review, and information gathered this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

LIC9099 (FAS) - (06/04)

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