197609758-9-22-2022-31-AS-RRAZ-CKGRZJ-20221023132756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609758
Report Date: 01/20/2022
Date Signed: 09/22/2022 03:13:18 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
01/12/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20220112143232

FACILITY NAME:	DANIAS SENIOR HOME		FACILITY NUMBER:	197609758
ADMINISTRATOR:	BAEZA, DANIA ELISABETH		FACILITY TYPE:	740
ADDRESS:	22331 COVELLO ST		TELEPHONE:	(747) 226-3342
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91303
CAPACITY:	6	CENSUS: 5	DATE:	01/20/2022
		UNANNOUNCED	TIME BEGAN:	11:59 AM
MET WITH:	Dania Baeza		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Resident was left in soiled diapers
Resident was restrained

INVESTIGATION FINDINGS:

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At approximately 11:59 PM on 01/20/22, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, initial 10-day visit for Complaint Control Number 31-AS-20220112143232. LPA met with the Licensee and disclosed the reason for the visit.

Census: 5

Regarding the allegation “Resident was left in soiled diapers”, it was alleged Resident #1 (R1) was soaked and unchanged. LPA conducted interviews on 01/12/22 at 4:08 PM and on 01/20 from approximately 12:40 PM to approximately 1:40 PM. Based on interviews, LPA learned R1 may have been left in soiled diapers. On 01/20/22 at approximately 1:40 PM, LPA viewed photographs taken on 01/12/22 of R1. Based on observation of photographs, LPA could not determine any evidence of saturation or defecation. LPA observed the resident during a physical plant tour on 01/20/22 at approximately 12:15 PM and detected no evidence of soiled diapers.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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-20220112143232

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: DANIAS SENIOR HOME	FACILITY NUMBER: 197609758
	VISIT DATE: 01/20/2022

NARRATIVE

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Based on interviews and observations, LPA did not encounter sufficient evidence to determine R1 was left in soiled diapers. Therefore, the above allegation is deemed unsubstantiated at this time.
Exit interview conducted and report issued.

Regarding the allegation “Resident was restrained”, it was alleged the wheelchair of Resident #1 (R1) was tied to the bed, restricting R1’s movement. LPA conducted interviews on 01/12/22 at 4:08 PM and on 01/20/22 from approximately 12:40 PM to approximately 1:40 PM. Based on interviews, LPA did not find sufficient evidence to support the allegation. LPA observed R1 during a physical plant tour on 01/20/22 at approximately 12:15 PM. Based on observation, LPA determined R1 was not restrained and unrestricted. Based on observations and interviews, the above allegation is deemed unsubstantiated at this time.

Exit interview conducted and report issued.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022

LIC9099 (FAS) - (06/04)

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