<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609728
Report Date: 08/23/2024
Date Signed: 08/23/2024 01:44:01 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
09/06/2022 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20220906130201
FACILITY NAME:TERNUS ADULT 2FACILITY NUMBER:
197609728
ADMINISTRATOR:TERNUS, TYLERFACILITY TYPE:
735
ADDRESS:39207 COCKNEY STTELEPHONE:
(661) 878-8433
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:4CENSUS: 4DATE:
08/23/2024
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Tyler TernusTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility not following client/staff ratio.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/23/2024 at 11:20 am Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced subsequent visit to this facility to investigate the above stated allegation. There was no answer at the door. LPA called Administrator and stated the purpose of the visit. Administrator Tyler Ternus arrived shortly after.

On 09/06/2022, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding the allegation mentioned above.

On 09/07/2022, LPA Melissa Spaeth initiated the complaint visit, followed by a subsequent visit on 02/02/2023, both visits were deemed Needs Further Investigation. On both visits LPA Spaeth conducted a tour of the facility and obtained copies of pertinent information. LPA Spaeth also conducted interviews with the Administrator and one (1) staff member. LPA Casillas reviewed documents collected by LPA Spaeth. LPA Casillas also reviewed interviews conducted by LPA Spaeth.
Continued LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
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 2
Control Number 31-AS-20220906130201
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: TERNUS ADULT 2
FACILITY NUMBER: 197609728
VISIT DATE: 08/23/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
At 12:30 PM LPA Casillas conducted a physical plant tour. During the investigation, LPA interviewed Administrator and LPA conducted record reviews from 11:45 am to 12:30 pm. LPA requested copies of updated resident roster, updated LIC 500, Administrator Certificate and bond certificate, Administrator will email copies to LPA. There were no clients in the home as they were all at day programs.

Allegation: Facility not following client/staff ratio.

It is alleged that the facility is not following client/staff ratio. Regarding this allegation it is reported that the facility is not providing an adequate number of staff members to accommodate all clients in care. LPA Casillas interviewed Administrator and it was revealed that at the time of this complaint, there were three (3) clients living in the facility. Administrator stated that one (1) facility staff member as required by regulation was present when clients were present and one (1) staff member from a vendorized one on one (1:1) company, Behavior Respid and Action (BRIA) provided care for one (1) client as required by appraisal and approved by North Los Angeles Regional Center (NLARC). LPA reviewed appraisals for all three (3) clients, and it was discovered that only one (1) client out of three (3) required 1:1 care from vendor at that time. Therefore, based on file reviews, interviews, and observations this allegation is deemed Unsubstantiated at this time.

No citation issued. Exit interview conducted. Copy of report provided to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2