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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609743
Report Date: 04/13/2022
Date Signed: 04/13/2022 10:05:52 AM

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
04/08/2022 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20220408123519
FACILITY NAME:ELWYN CALIFORNIA - QUARTZFACILITY NUMBER:
197609743
ADMINISTRATOR:JOSEPH TIGHEFACILITY TYPE:
737
ADDRESS:8033 QUARTZ AVETELEPHONE:
(925) 626-7014
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:2CENSUS: 2DATE:
04/13/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Stephen WamalaTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Facility did not ensure that staff have current certifications on file.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to facility to investigate the above allegation. LPA met with the administrator, Stephen Wamala, and advised him of the investigation. It's being alleged that the facility failed to update staff's First-Aid certificates, which had expired in 2021. Furthermore, it was reported that facility staff did not have either a current or required hands-on training as stated in the regulation. During the course of the investigation, LPA Cava conducted interviews and record review. LPA also advised the administrator that Community Care Licensing (CCL) received a Corrective Action Plan (CAP) from North Los Angeles County Regional Center (NLACRC).

Based on the information obtained, there is sufficient evidence to confirm the allegation. Therefore investigation is Substantiated. Mr. Wamala was advised. Appeal rights and a copy of this report provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
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 2
Control Number 31-AS-20220408123519
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: 04/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/20/2022
Section Cited
CCR
85165(f)(7)
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Emergency Intervention Staff Training: The administrator who will approve the continued use of a manual restraint or seclusion shall complete additional training which shall include the following: Current first aid certification and current certification in the use of cardiopulmonary Resuscitation (CPR)
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Licensee was already given a corrective action plan which is ongoing. Once CAP completed, licensee will submit a copy as proof of completion. No further corrections needed.
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This requirement has not been met as evidenced by CCL receiving a CAP revealing that staff first aid certificates had expired in 2021.
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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: 04/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2