197610076-3-21-2024-31-AS-NGID-D4ZPY7-20240506114325

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610076
Report Date: 03/21/2024
Date Signed: 03/21/2024 11:53:05 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
03/20/2024 and conducted by Evaluator Lorena Casillas

COMPLAINT CONTROL NUMBER: 31-AS-20240320154444

FACILITY NAME:	ELEVATED HOME HEALTH		FACILITY NUMBER:	197610076
ADMINISTRATOR:	GOODWIN, BYRANISHA		FACILITY TYPE:	740
ADDRESS:	44663 2ND STREET EAST		TELEPHONE:	(702) 823-8166
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	2	CENSUS: 1	DATE:	03/21/2024
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Byranisha Goodwin		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Staff touched resident inappropriately.

INVESTIGATION FINDINGS:

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On 03/21/24 at 09:05 am Licensing Program Analyst (LPA), Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegation. LPA met with Administrator Byranisha Goodwin and explained the reason for the visit.

At 09:10 AM LPA Casillas conducted a physical plant tour. During the investigation, interviews and record reviews were conducted. LPA requested copies of resident roster, liability insurance and LIC 500. LPA requested copies of pertinent information relevant to the investigation including but not limited to appraisals, police reports, police agency information and any information pertaining to residents and care, all requested copies of documents will be emailed to LPA by end of today as there is no copy machine at the facility, however Administrator has the ability to scan documents.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

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-20240320154444

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ELEVATED HOME HEALTH	FACILITY NUMBER: 197610076
	VISIT DATE: 03/21/2024

NARRATIVE

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Allegation#1: Staff touched resident inappropriately.

It is alleged that staff touched a resident inappropriately. Regarding this allegation it was reported that staff member “Misha” sat in the resident’s room for eight (8) hours and just watched them sleep, then at some point of the night staff member fondled resident without their consent. LPA toured the home at 9:10 am. LPA interview Administrator at 09:25 am and attempted to interview Resident #1 (R1). LPA interviewed Administrator and denied that she or any staff touched the resident inappropriately. The Administrator stated that R1 was upset because of some property that he felt was missing, police were called by resident but not for inappropriate touching. There was no police report made as the police felt that there was no crime to report. LPA attempted to interview R1 however the resident was uncooperative and refused to answer any questions. At 9:50 am LPA reviewed R1s file. Therefore, due to interviews and observations this allegation is UNSUBSTANTIATED at this time.

No citations issued. Copy of this report given to Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC9099 (FAS) - (06/04)

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