197609741-4-18-2024-31-AS-EMIR-D5BPEF-20240516111501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609741
Report Date: 04/18/2024
Date Signed: 04/18/2024 03:09:38 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
04/18/2024 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20240418110559

FACILITY NAME:	TRACY'S BOARDING CARE - HIAWATHA		FACILITY NUMBER:	197609741
ADMINISTRATOR:	JOY, ANCY		FACILITY TYPE:	740
ADDRESS:	17441 HIAWATHA ST		TELEPHONE:	(818) 455-2586
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 4	DATE:	04/18/2024
		UNANNOUNCED	TIME BEGAN:	11:43 AM
MET WITH:	Thresiamma Mathew		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Licensee abandoned the facility
Licensee did not follow proper transfer/sale guidelines
Unlicensed care is being provided

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Ray Comer, Gary Tan and Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPAs met with the current licensee/administrator, Thresiamma "Tracy" Mathew, the current administrator, Violeta Tagatac, and the applicant/administrator, Araceli Andrade and advised them of the complaint. Today's investigation consisted of interviews with the administrators and residents. LPA's also conducted a physical plaint inspection and record review. According to Tracy, this facility was placed on sale on or around 10/30/23. Community Care Licensing (CCL) was also notified of this on 10/30/23. Interviews with both Vioileta and Araceli confirm this information. There is a pending application, under Andrew's Boarding Care LLC #197610590, that was received on 02/23/24. All three confirmed facility was never abandoned. Despite the sale, Tracy and Violeta has continued to oversee the everday operation and has agreed to do so until Araceli's application to operate is approved. Furtheremore, Tracy stated current staff are on her payroll. Attempts to interview four (4) of four residents could not corroborate the allegations. Based on the information obtained, the above allegations are deemed Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

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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