197609728-9-13-2024-31-AS-TAGD-D9EMLG-20240924094218

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609728
Report Date: 09/13/2024
Date Signed: 09/13/2024 09:42:25 AM

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
08/28/2024 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20240828103042

FACILITY NAME:	TERNUS ADULT 2		FACILITY NUMBER:	197609728
ADMINISTRATOR:	TERNUS, TYLER		FACILITY TYPE:	735
ADDRESS:	39207 COCKNEY ST		TELEPHONE:	(661) 878-8433
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	4	CENSUS: 4	DATE:	09/13/2024
		UNANNOUNCED	TIME BEGAN:	07:50 AM
MET WITH:	Anthony Contreras		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

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Staff member is under the influence while providing care and supervision to residents in care.
Staff hit resident(s) in care.
Licensee does not ensure that residents' needs and services plan(s) are adhered to.
Staff are serving expired food to residents in care, causing illness
Staff do not ensure that resident's personal care needs are being met while in care.
Staff do not adequately handle medical incident(s) involving resident(s) in care.

INVESTIGATION FINDINGS:

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On September 13, 2024 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth met with Anthony Contreras, the Back-Up Administrator and explained the purpose of this visit was to investigate the complaint and deliver findings.

The investigation consisted of the following: On 9/04/2024, LPA conducted an initial complaint investigation. LPA attempted to interview three clients (C1-C4) at 8:30 am until 8:45 am. LPA toured the facility at 8:45 am until 9:00 am and LPA interviewed the back-up Administrator at 9:00 am until 9:10 am. During LPA’s visit, LPA received copies of the resident roster, staff phone numbers, and the clients’ documentation. LPA Spaeth interviewed six (6) out of the thirteen (13) staff members (S1 – S6) and the Licensee/Administrator on 9/10/2024 at 4:00 pm until 5:00 pm.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

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 31-AS-20240828103042

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: TERNUS ADULT 2	FACILITY NUMBER: 197609728
	VISIT DATE: 09/13/2024

NARRATIVE

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The investigation revealed the following. Regarding the allegation: Staff member is under the influence while providing care and supervision to residents in care. It’s being alleged that the Licensee/Administrator, keeps alcohol in the facility office and drinks on the job. LPA attempted to interview C1-C3 but was unable due to communication barriers. C4 was unavailable for an interview. S1-S6 unanimously stated this did not occur. The Administrator denied the allegation. During the facility tour, LPA did not observe any alcohol.

Regarding the allegation: Staff hit resident(s) in care. It’s being alleged that the clients were hit by the Licensee/Administrator and when it is reported to the Licensee no action is taken. LPA attempted to interview C1-C3 but was unable to due to communication barriers. C4 was unavailable for an interview. S1-S6 unanimously stated this did not occur. The Administrator denied the allegation.

Regarding the allegation: Licensee does not ensure that residents' needs and services plan(s) are adhered to. It’s being alleged that the clients are not provided the services they require such as speech therapy. LPA attempted to interview C1-C3 but was unable to due to communication barriers. C4 was unavailable for an interview. S1-S6 and the Administrator unanimously denied the allegation. The Administrator stated none of the clients require speech therapy. LPA Spaeth reviewed residents’ Individual Program Plan (IPP) documentation and observed the residents are receiving the services needed.

Regarding the allegation: Staff are serving expired food to residents in care, causing illness. It’s being alleged the facility food is expired and the clients were sick as a result. LPA attempted to interview C1-C3 but was unable due to communication barriers. C4 was unavailable for an interview. S1-S6 and the Administrator unanimously stated the facility food is not expired and the clients have not become sick due to expired food. S6 stated they check the food to ensure the food is not expired. During LPA’s 9/04/2024 visit, LPA did not observe expired food within the facility.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 31-AS-20240828103042

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: TERNUS ADULT 2	FACILITY NUMBER: 197609728
	VISIT DATE: 09/13/2024

NARRATIVE

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Regarding the allegation: Staff do not ensure that resident's personal care needs are being met while in care. LPA attempted to interview C1-C3 but was unable due to communication barriers. C4 was unavailable for an interview. S1-S6 unanimously confirmed they feed the clients, assist with showering and brushing the clients’ teeth. The Administrator denied the allegation. LPA received copies of the staff daily logs for 9/11/2024 and 9/12/2024 which documents staff have assisted with the client’s personal care needs.

Regarding the allegation: Staff do not adequately handle medical incident(s) involving resident(s) in care. Also, it’s being alleged medical incidents are not reported. LPA attempted to interview C1-C3 but was unable due to communication barriers. C4 was unavailable for an interview. S1-S6 and the Administrator unanimously stated all medical incidents are reported. LPA reviewed the facility incident reports and did not observe any medical incidents.

Based upon the review of facility documentation and interviews of staff, the allegations are unsubstantiated.

Exit interview conducted and a copy of the report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

LIC9099 (FAS) - (06/04)

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