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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609704
Report Date: 02/10/2023
Date Signed: 02/10/2023 12:41:06 PM

Unsubstantiated


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
12/21/2022 and conducted by Evaluator Melissa Ruiz
COMPLAINT CONTROL NUMBER: 31-AS-20221221152542
FACILITY NAME:SAFE LAUREL LLCFACILITY NUMBER:
197609704
ADMINISTRATOR:GBOYEGA AKINBOLAFACILITY TYPE:
735
ADDRESS:16300 VINTAGE STTELEPHONE:
(818) 489-1218
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:4CENSUS: DATE:
02/10/2023
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Angelina OseiTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Staff are not safeguarding resident's personal property.
Staff forced resident to give away their food to another resident.
Staff are harassing resident in care.
Staff are not preventing residents from harassing other resident while in care.
Lack of supervision resulting in resident receiving tampered food.
INVESTIGATION FINDINGS:
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On 2/10/2023, Licensing Program Analyst (LPA) Melissa Ruiz arrived at the facility to conduct an unannounced subsequent complaint visit. Upon arrival, LPA was greeted by staff, and an entrance interview was conducted, the purpose of the visit was explained. Administrator designated staff to sign this report. On 12/28/2022, LPA Ruiz conducted an initial 10-day visit, and conducted interviews with the Licensee, the Administrator, and one staff (S1). On 2/2/2023, LPA collected relevant documents pertinent to this investigation. On 2/6/2023, LPA conducted interviews with two (2) clients. On 2/8/23, LPA interviewed staff 2 (S2).

Allegation: Staff are not safeguarding resident’s personal property.
Allegation: Staff forced resident to give away their food to another resident.

To investigate these allegations, on 12/28/22, LPA conducted interviews with the licensee, the Administrator, and 2 staff on 2/6/23 and 2/8/23.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
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 4
Control Number 31-AS-20221221152542
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: SAFE LAUREL LLC
FACILITY NUMBER: 197609704
VISIT DATE: 02/10/2023
NARRATIVE
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Allegation: Staff are not preventing residents from harassing other resident while in care. LPA interviewed two (2) clients on 2/6/23. According to the licensee, a client (C1) has been vocalizing issues with their personal food. C1 believes that staff and or another client (C2) has been using their food to share, however on an interview conducted with C1 on 2/6/23, C1 denied the staff are making C1 share their food. Licensee stated that C1 has their own cabinet in the pantry and designated area in the refrigerator. Licensee also stated there was one occasion where they offered soup on the menu, and staff asked C1 if they wanted to share their soup, to which C1 said no and therefore, it was not used. A staff (S1) stated that with C1’s personal food, they do not use it, unless C1 specifically offers it to another person such as C2 or staff, which tends to happen periodically. S1 stated that they document on daily notes occasions when C1 offers to share their food. On 2/8/23, LPA interviewed S2 and S2 denied both allegations mentioned above. Due to interviews conducted, the allegations mentioned above are Unsubstantiated at this time.

Allegation: Staff are harassing resident in care.

To investigate these allegations, LPA conducted interviews with the licensee, the administrator, two (2) clients, and two (2) staff. On 12/28/22, according to the Licensee, some staff are Spanish speakers, and often communicate in Spanish. C1 has made comments thinking that they are “laughing” at C1, but the Licensee stated that she does not have reason to believe staff are speaking bad about any client. According to S1, she was aware C1 sent text messages to another staff accusing that staff of talking about C1, but we do not. S1 states that C1 says things to staff, and when they do, staff just listen but S1 has never harassed C1 with words or witnessed other staff doing so. Additionally, the Administrator and the licensee stated that C1 has brought up issues regarding things C2 is doing to C1, such as C2 spying on C1, however both the licensee and Administrator believe that this is due to C1’s need for medication adjustment. According to the licensee, C1 has stated that they think C2 is spying on them, however the licensee does not believe that to be true. On 2/2/23, LPA reviewed a Medical Appointment Form, regarding a doctor’s visit to adjust C1’s medication due to their medical diagnosis.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20221221152542
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: SAFE LAUREL LLC
FACILITY NUMBER: 197609704
VISIT DATE: 02/10/2023
NARRATIVE
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To investigate these allegations, on 12/28/22, LPA conducted interviews with the licensee, the Administrator, and 2 staff on 2/6/23 and 2/8/23. LPA interviewed two (2) clients on 2/6/23. According to the licensee, a client (C1) has been vocalizing issues with their personal food. C1 believes that staff and or another client (C2) has been using their food to share, however on an interview conducted with C1 on 2/6/23, C1 denied the staff are making C1 share their food. Licensee stated that C1 has their own cabinet in the pantry and designated area in the refrigerator. Licensee also stated there was one occasion where they offered soup on the menu, and staff asked C1 if they wanted to share their soup, to which C1 said no and therefore, it was not used. A staff (S1) stated that with C1’s personal food, they do not use it, unless C1 specifically offers it to another person such as C2 or staff, which tends to happen periodically. S1 stated that they document on daily notes occasions when C1 offers to share their food. On 2/8/23, LPA interviewed S2 and S2 denied both allegations mentioned above. Due to interviews conducted, the allegations mentioned above are Unsubstantiated at this time.

Allegation: Staff are harassing resident in care.


Allegation: Staff are not preventing residents from harassing other resident while in care.

To investigate these allegations, LPA conducted interviews with the licensee, the administrator, two (2) clients, and two (2) staff. On 12/28/22, according to the Licensee, some staff are Spanish speakers, and often communicate in Spanish. C1 has made comments thinking that they are “laughing” at C1, but the Licensee stated that she does not have reason to believe staff are speaking bad about any client. According to S1, she was aware C1 sent text messages to another staff accusing that staff of talking about C1, but we do not. S1 states that C1 says things to staff, and when they do, staff just listen but S1 has never harassed C1 with words or witnessed other staff doing so. Additionally, the Administrator and the licensee stated that C1 has brought up issues regarding things C2 is doing to C1, such as C2 spying on C1, however both the licensee and Administrator believe that this is due to C1’s need for medication adjustment. According to the licensee, C1 has stated that they think C2 is spying on them, however the licensee does not believe that to be true. On 2/2/23, LPA reviewed a Medical Appointment Form, regarding a doctor’s visit to adjust C1’s medication due to their medical diagnosis.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20221221152542
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: SAFE LAUREL LLC
FACILITY NUMBER: 197609704
VISIT DATE: 02/10/2023
NARRATIVE
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On 2/6/23, LPA interviewed C1, and C1 stated the Licensee talks about C1 with other staff. C1 also believes that another client, C2 does malicious things like lock them out. An interview with C2 on 2/6/23 revealed that C2 feels comfortable in the home, no issues with staff, and C2 has not witnessed any harassment from staff. LPA interviewed S2 on 2/8/23, and S2 denied both allegations above. Due to interviews conducted and record review, the allegations mentioned above are Unsubstantiated at this time.


Allegation: Lack of supervision resulting in resident receiving tampered food.

To investigate these allegations, LPA conducted interviews with the licensee, and two (2) clients, and two (2) staff. LPA interviewed the Licensee on 12/22/22, to which the licensee stated that there was a time where a staff member used a dull knife to cut pizza, because they do not have a pizza cutter. The pizza slice C1 had received was torn imperfectly due to a dull knife that was used to cut the slice and C1 accused staff of taking a bite of their slice. On 2/6/2023, LPA interviewed C1, and they stated that they cook their own food often, but C1 believes that staff have purposely ate a slice of their pizza. On this date, LPA also interviewed C2, and C2 stated that they are happy with the food they get, and they have never suspected staff of tampering with their food. On 2/8/23, LPA interviewed S2 and S2 denied any clients receiving tampered food. Due to interviews conducted there is insufficient evidence to prove that the allegation may or may not have happened, therefore, the allegation mentioned above is Unsubstantiated at this time.

No deficiencies issued, per CA Code of Regulations, Title 22. Report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4