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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609743
Report Date:
10/11/2021
Date Signed:
10/11/2021 02:31:55 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
10/07/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20211007082852
FACILITY NAME:
ELWYN CALIFORNIA - QUARTZ
FACILITY NUMBER:
197609743
ADMINISTRATOR:
JOSEPH TIGHE
FACILITY TYPE:
737
ADDRESS:
8033 QUARTZ AVE
TELEPHONE:
(925) 626-7014
CITY:
WINNETKA
STATE:
CA
ZIP CODE:
91306
CAPACITY:
2
CENSUS:
2
DATE:
10/11/2021
UNANNOUNCED
TIME BEGAN:
12:00 PM
MET WITH:
Henry Sessanga
TIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit client
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegation above. LPA met with facility staff and explained the reason for this visit. LPA spoke with the administrator by telephone and explained the reason for this visit.
It is alleged that on an outing for lunch on 10/6/21 that client #1 (C1) was hit on the head by staff # 1(S1).
LPA conducted interviews with staff over the telephone and in person regarding this allegation from approximately 12:30-1:30 pm. LPA also called the location where the lunch outing took place and spoke with the manager regarding the allegation. Information obtained through interviews reveal that no one witnessed S1 hit C1 at all during the lunch outing. LPA also obtained a copy of the staff schedule for that day. LPA attempted to interview C1 but they would not understand what was being asked. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time. Exit interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME
:
Cassandra Harris
LICENSING EVALUATOR NAME
:
Wendell Smith
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2021
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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