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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609889
Report Date:
12/23/2021
Date Signed:
12/23/2021 02:39:56 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
12/10/2021
and conducted by Evaluator
Eleza Jackson
COMPLAINT CONTROL NUMBER:
31-AS-20211210153243
FACILITY NAME:
PEARL OF WEST HILLS, INC
FACILITY NUMBER:
197609889
ADMINISTRATOR:
IRINA, KARBACHINSKIY
FACILITY TYPE:
740
ADDRESS:
23427 VICTORY BLVD
TELEPHONE:
(818) 854-6306
CITY:
WEST HILLS
STATE:
CA
ZIP CODE:
91307
CAPACITY:
6
CENSUS:
4
DATE:
12/23/2021
UNANNOUNCED
TIME BEGAN:
01:47 PM
MET WITH:
Irina Karbachinskiy
TIME COMPLETED:
02:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hits residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day Licening Program Analyst (LPA) Eleza Jackson conducted a facility tour to ensure no immediate health and safety issues were present. LPA Jackson did not observe any immediate health and safety issues. LPA Jackson met with the facility administrator upon her arrival at approximately 1430hrs and explained the reason for this visit.
It is alleged that the facility administrator hits residents in the facility. LPA Jackson was unable to locate former resident(s).
Based on the inability to locate former resident(s) this allegation is deemed Unsubstantiated at this time.
Exit interview conducted and copy of report emailed to administrator with signature.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME
:
Cassandra Harris
LICENSING EVALUATOR NAME
:
Eleza Jackson
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/23/2021
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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