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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609743
Report Date:
11/09/2021
Date Signed:
11/09/2021 02:40:05 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
11/05/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20211105164217
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:
11/09/2021
UNANNOUNCED
TIME BEGAN:
01:10 PM
MET WITH:
Joseph Tighe
TIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
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5
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8
9
Staff did not make sure resident was seen by a physician
Staff are not providing adequate food service to resident
INVESTIGATION FINDINGS:
1
2
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5
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7
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9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced initial complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit.
Staff did not make sure resident was seen by a physician
It is alleged that around 10/31/21 that client #1 (C1) was not feeling good and the facility did not ensure C1 was seen by a physician. LPA conducted an interview with the administrator regarding this allegation from approximately 1:15-1:30pm regarding this allegation. LPA reviewed C1's facility file and obtained copies of pertinent information from 1:30-1:45pm. Information revealed that C1 went to their families home and came back to the facility on 10/31/21 and was not feeling well when they came back. Administrator spoke with C1's family and had a tele-visit with C1's physician where a prescription for medicine was put in for C1. C1 was also checked out by the facility nurse. Based on the information obtained by interviews and documents obtained this allegation is deemed Unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME
:
Cassandra Harris
LICENSING EVALUATOR NAME
:
Wendell Smith
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/09/2021
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-20211105164217
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:
ELWYN CALIFORNIA - QUARTZ
FACILITY NUMBER:
197609743
VISIT DATE:
11/09/2021
NARRATIVE
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Staff are not providing adequate food service to resident
It is alleged that client #2 (C2) is on a gluten free diet and that C1 is made to eat all gluten free food. LPA conducted an interview with the administrator regarding this allegation. LPA also conducted a physical plant walk through from 1:10-1:20pm where the food supply was checked. LPA also did a file review from 1:30-1:45pm. Information from the file review revealed C2 is not on a gluten free diet and that C1 is on a gluten free diet. LPA attempted to interview C1 and C2 but they were not able to comprehend what was being asked of them. When LPA checked the food supply LPA observed there to be different options of food for both C1 and C2. LPA observed there to be gluten free products along with gluten products. Based on the information obtained through observation and interviews this allegation is deemed Unsubstantiated at this time.
Exit interview conducted.
SUPERVISORS NAME
:
Cassandra Harris
LICENSING EVALUATOR NAME
:
Wendell Smith
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/09/2021
LIC9099
(FAS) - (06/04)
Page:
2
of
2