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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609743
Report Date: 10/11/2022
Date Signed: 10/11/2022 02:19:03 PM

Substantiated


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
10/07/2022 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20221007145103
FACILITY NAME:ELWYN CALIFORNIA - QUARTZFACILITY NUMBER:
197609743
ADMINISTRATOR:STEPHEN WAMALAFACILITY TYPE:
737
ADDRESS:8033 QUARTZ AVETELEPHONE:
(925) 626-7014
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:2CENSUS: 2DATE:
10/11/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Stephen WamalaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility is in disrepair
Kitchen sink emits an odor
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with the administrator, Stephen Wamala, and advised him of the purpose of the visit. On or about 10/05/2022 the facility had an in-person visit from Regional Center and it was observed that the kitchen sink had a strong foul odor. It was also observed that the kitchen sink faucet is loose and there is no clear indication which way the hot water and cold water is turned on. During the course of the visit, LPA conducted an interview with the administrator and a physical plant inspection.

Between 11:30am and 12:30pm, LPA conducted his interview with the administrator and it was acknowledged that a visit was made by Regional Center on 10/05/2022. After the issue with the faucet/sink was addressed, the administrator notified a technician to make an appointment for repair. The appointment was conducted by the technician on 10/07/2022. The technician addressed both the odor and the loose faucet, and to indicate the flow of hot and cold water.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
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 3
Control Number 31-AS-20221007145103
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: 10/11/2022
NARRATIVE
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Between 12:30pm and 1:30pm, a physical plant inspection was made to insure compliance. Common areas, the kitchen and both bathroom sinks were inspected to insure that facility faucets and sinks has no foul odor, and that there are no loose faucets. Direction of hot and cold water was also checked.

Although the issues with the water and kitchen sink has already been addressed by the administrator on 10/07/22, the allegations of the sink had a strong odor and is loose is Substantiated. Citation, with correction indicated on the 9099D. The administrator was advised and a copy of this report given.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20221007145103
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2022
Section Cited
CCR
80087(a)
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Buildings and Grounds: The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement has not been met as evidenced by a visit from Regional Center on 10/05/22, reporting that the kitchen sink had a stron odor and
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Administrator has since hired a technician to address the odor coming from the sink, the loose faucet in the kitchen, and the indication of which way the hot and cold water is turned on. This was checked during the physical plant inspection. No further corrections required.
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the kitchen faucet is loose with no clear indication which way the hot and cold water is turned on. This may pose a potential health and safety risk to the clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3