197609885-10-7-2022-31-AS-MRUZ-CJYS2R-20221007132957

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609885
Report Date: 10/07/2022
Date Signed: 10/07/2022 01:30:42 PM

Document Has Been Signed on 10/07/2022 01:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	EPHRATAH HOME 1		FACILITY NUMBER:	197609885
ADMINISTRATOR:	AHIABOR, FRANCESS		FACILITY TYPE:	735
ADDRESS:	4605 W. AVENUE J12		TELEPHONE:	(818) 310-7602
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY: 4		CENSUS: 3	DATE:	10/07/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Francess, Ahiabor		TIME COMPLETED:	01:35 PM

NARRATIVE

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At 12:00 p.m., Licensing Program Analyst (LPA) Melissa Ruiz arrived at the facility to conduct an unannounced subsequent case management visit. The purpose of the visit is to follow-up and issue the final report of an incident which occurred 7/27/2021. Upon arrival, LPA met with the Administrator, Francess Ahiabor.

This investigation was conducted by Investigator Robert Kujawa with the Community Care Licensing Division’s (CCLD) Investigations Branch (IB).

On 7/29/2021, the Woodland Hills Regional Office received an incident report wherein Client 1 (C1) was reported to have been found deceased in a park by the local police department. It was alleged that neglect/lack of supervision occurred due to this incident.

During the investigation, interviews with the Administrator, staff and clients were held between 9/14/2021 and 12/13/2021.

Investigator Kujawa interviewed the Administrator on 9/14/2021. The Administrator stated that this was a Level 2 facility, therefore clients can come and go as they please. She also stated that C1 had never gone missing before and regards to drug use, she believed C1 would use drugs when C1 were around bad friends.

The Administrator said that on the morning of 6/4/2021, she drove C1 to a dentist appointment, where C1 stated that after their appointment, they would hang out with some friends at the park, but that they would be back to the facility later in the day.

(cont. LIC809-C)

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: EPHRATAH HOME 1	FACILITY NUMBER: 197609885
	VISIT DATE: 10/07/2022

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Later that day, the Administrator received a phone call from the dentist’s office asking if C1 was still coming to their appointment, as C1 had not shown up. Much later that day, the facility received a phone call from C1 where they said preferred to hang out with friends at the park instead of going to their dentist appointment. C1 also stated they would call the facility when they were ready to be picked up. On that same day, as it became nighttime, the Administrator called C1 multiple times and C1 did not respond to the calls. The Administrator went to the park where C1 frequently visits, but she was unable to locate C1.

The next day, 6/5/2021, C1 had still not returned to the facility and did not respond to any of the Administrator’s phone calls. The Administrator then contacted the Local Police Department to report them missing, but she was told that because clients can come and go as they please, they were not considered a missing person at that time. The police told the Administrator to contact them again after one week. The Administrator continued to attempt to contact C1’s cellphone several times from 6/5/2021 to 6/6/2021.

On 6/7/2021, the Administrator contacted the police yet again requesting assistance with C1’s disappearance. The police arrived later that day and filed a missing person’s report.

On 12/13/2021, Investigator Kujawa interviewed Staff 1 (S1). S1 stated that the facility serves clients who are high functioning and independent. S1 was questioned as to the protocol for when clients leave the facility, in which S1 stated there is a logbook where clients sign in and sign out. S1 stated that C1 was independent, high functioning and only required medication assistance. S1 also stated C1 would frequently leave the facility unsupervised and would go to the park. S1 stated C1 had no known involvement with drugs and S1 did not note any unusual behavior the date of their disappearance, 6/4/2021.

On 12/13/2021, Investigator Kujawa also conducted interviews with Client 2 (C2) and Client 3 (C3). C2 stated they did not know anything about C1. C2 did not express any issues or concerns with staff. C2 stated they can leave the facility as they please and confirmed there is a sign-in sheet that is filled out each time they leave the facility.

(Cont. on LIC9099C)

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: EPHRATAH HOME 1	FACILITY NUMBER: 197609885
	VISIT DATE: 10/07/2022

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C2 has not had any issues when it comes to returning to the facility and does not have any issues communicating their needs to the Administrator. C3 states they are independent and are able to leave the facility without supervision. C3 signs states they sign out using the logbook per the facility’s protocol. C3 did not express any regarding communicating with staff and states staff are able to meet their needs. C3 states they recall who C1 was, but they did not have much interaction. No further information was provided by C2 and C3.

On 1/4/2022 Investigator Kujawa obtained pertinent records such as the pre-licensing report where it states that the facility is a Level 2 North Los Angeles Region Center vendored facility.

On 1/5/2022, Investigator Kujawa received and reviewed the Los Angeles Sheriff’s Department Police Report. The report reiterates the events that happened the day C1 went missing. Lastly, the report states that on 6/5/2021, C1 was found unresponsive at American Heroes Park and pronounced dead by Los Angeles Fire Department.

On 8/9/2022 LPA Ruiz conducted a record review of the following:
· C1’s physician’s report dated 10/30/2020
· Individualized Program Plan (IPP) dated 11/30/2020
· Appraisal Needs and Services dated 1/6/2020

C1’s physician report states that the client is able to leave the facility unassisted. C1’s IPP states that C1 is allowed to access the community independently. Lastly, the Appraisal Needs and Services Plan dated 1/6/2021 states that C1 was 100% independent and often frequented the park to play basketball.

Based on interviews and record review, there was sufficient evidence to conclude that the facility staff provided appropriate supervision per the client’s physician report, IPP and Appraisal Needs and Service plan. The facility followed all requirements for reporting the incident to the licensing agency and local law enforcement. No deficiency issued. An exit interview was conducted with the Administrator. Report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

LIC809 (FAS) - (06/04)

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