197609743-7-11-2023-31-AS-NMAN-D58N34-20240513100539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609743
Report Date: 07/11/2023
Date Signed: 07/11/2023 04:15:03 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
04/19/2023 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20230419135106

FACILITY NAME:	ELWYN CALIFORNIA - QUARTZ		FACILITY NUMBER:	197609743
ADMINISTRATOR:	STEPHEN WAMALA		FACILITY TYPE:	737
ADDRESS:	8033 QUARTZ AVE		TELEPHONE:	(925) 626-7014
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY:	2	CENSUS: 2	DATE:	07/11/2023
		UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Stephen Wamala		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Facility is unkept
Staff are not cleaning debris found in facility
Hazardous items are accessible to residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Tihesha Smith made a subsequent unannounced complaint visit to the facility and met with facility staff and explained the purpose of this visit. The administrator was present at the facility.
During initial visit, on 04/20/2023, LPA Smith conducted tour of physical plant at 2:40 pm, conducted an interview with the administrator and requested documents relevant to the investigation at 3:18 pm.
Facility is unkept
At approximately 11:26 pm, LPA conducted a physical plant tour, interviewed five (5) staff, and requested additional pertinent documents at 3:50 PM. During the physical plant tour on 04/20/2023, LPA did not observe any garbage inside the facility, in common areas, resident bedrooms or outside on the the facility grounds. The common areas, furniture and grounds observed to be clean and in functional condition. LPA did however observe a blocked area on the patio in front of kitchen due to active kitchen repair in progress.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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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Control Number 31-AS-20230419135106

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: 07/11/2023

NARRATIVE

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(Cont. from 9099)

During today’s visit, LPA toured kitchen, patio, common areas and grounds. The kitchen sink repair was completed, and the facility observed to be in good condition. Based on observations and interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Facility staff are not cleaning debris found in the facility

LPA Smith interview with six (6) out of six (6) staff reveal that staff clean facility daily and have assigned tasks on each shift to ensure assigned area in the facility is clean. Two (2) out of six (6) staff revealed an outside service comes to facility approximately once a month to do a deep thoroughly cleaning of the facility. During initial visit on 04/20/2023, LPA Smith observed staff cleaning the bathroom. LPA observed the facility to be clean and no debris found inside the facility or on the facility grounds during the visits conducted on: 04/20/2023 and 07/11/2023. Based on interviews and observations, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Hazardous items are accessible to residents in care

During the physical plant tour on 04/20/2023, LPA Smith did not observe any hazardous items left accessible to residents in care. LPA toured storage of toxins which was observed to be locked an inaccessible to residents in care. Interview with six (6) out of six (6) staff reveal that toxins are always locked and when an item is needed the item is retrieved and the toxins are immediately locked. Based on observations and interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC9099 (FAS) - (06/04)

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