197609853-9-23-2021-31-AS-NMAN-C7QV8W-20211012161322

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609853
Report Date: 07/27/2021
Date Signed: 09/23/2021 03:42:50 PM

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
07/20/2021 and conducted by Evaluator LaQueena Lacy

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20210720125321

FACILITY NAME:	REESEJOY CARE HOME II		FACILITY NUMBER:	197609853
ADMINISTRATOR:	RAMIREZ, ROBERTO		FACILITY TYPE:	740
ADDRESS:	17544 SAN JOSE ST		TELEPHONE:	(805) 832-8792
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS:	DATE:	07/27/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Roberto Ramirez		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility did not meet resident's hygiene needs.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) LaQueena Lacy and Angela Panushakina conducted an unannounced complaint visit for the above allegation. LPAs met with Administrator Roberto Ramirez and explained the purpose of this visit. The complainant was alleging that resident #1 (R1) was not bathed for a whole week because it is “too much work for the staff”. At 9:30am, with the assistance of the staff #1 (S1) LPAs conducted a physical plant tour and observed R1 in bed, covered in feces. LPAs observed S1 leaving R1’s room and walking towards the kitchen to wash the dishes. LPAs intervened and instructed S1 to go back to clean R1. At approximately 10:00am, LPAs reviewed facility files and obtained copies of documents pertinent to the investigation. Documents revealed that R1 is to be well groomed and kept clean. During this investigation, at 10:45am LPAs interviewed administrator, staff, and residents. Interviews revealed that R1 is to receive a bath two times a week, however, the last time R1 was given a bed bath, was one week ago. The allegation was the facility did not meet resident's hygiene needs. A review of documents conducted at 10:00am verified the information received from interviews. Based on observations and interviews, there is sufficient information to support the allegation. Therefore, the allegation is substantiated at this time. Citation issued, appeal rights discussed and given. Exit interview conducted. Copy of this report issued.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 586-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021

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 4

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
07/20/2021 and conducted by Evaluator LaQueena Lacy

COMPLAINT CONTROL NUMBER: 31-AS-20210720125321

FACILITY NAME:	REESEJOY CARE HOME II		FACILITY NUMBER:	197609853
ADMINISTRATOR:	RAMIREZ, ROBERTO		FACILITY TYPE:	740
ADDRESS:	17544 SAN JOSE ST		TELEPHONE:	(805) 832-8792
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS:	DATE:	07/27/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Robert Ramirez		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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9

Facility staff verbally abused resident while in care.

INVESTIGATION FINDINGS:

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This is an amended report to a complaint visit conducted on 07/27/2021 to change the finding.

Licensing Program Analysts (LPAs) LaQueena Lacy and Angela Panushakina conducted an unannounced initial 10-day complaint visit for the above noted allegation. LPAs met with Administrator Roberto Ramirez and explained the purpose of this visit.

It is alleged that staff yell and call resident #1 (R1) names. During this visit at 9:30am LPAs conducted a physical plant tour. At approximately 10:45am, LPAs began interviews with the Administrator, staff, and residents. Staff denied yelling at R1 or at other residents. LPAs interviews with two (2) out of three (3) residents, revealed that no one observed or overheard staff yell or verbally abuse anyone in care.

Based on observations and interviews, there is insufficient information to support the allegation. Therefore, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 586-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20210720125321

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: REESEJOY CARE HOME II	FACILITY NUMBER: 197609853
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/27/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/29/2021 Section Cited CCR 87464(d)	1 2 3 4 5 6 7	87464 (d) Basic Services A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs….and providing the other basic services… either directly or through outside resources.	1 2 3 4 5 6 7	Licencee will provide in-service training with staff. Create a check list of daily ADLs to assist staff to ensure all residents in care needs and services are met. Licensee shall email a copy of the in-service training and sign-in sheet to LPA.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by; The facility staff did not ensure that R1’s hygiene needs are met. R1 was not bathed for a week and observed to be covered in feces. This poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 586-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021

LIC9099 (FAS) - (06/04)

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