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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610088
Report Date: 09/22/2022
Date Signed: 10/19/2022 01:00:50 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
09/14/2022 and conducted by Evaluator Melissa Ruiz
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20220914083958
FACILITY NAME:TIGERTAIL ADULT HOME 4, INC.FACILITY NUMBER:
197610088
ADMINISTRATOR:HALLON, CHARYFACILITY TYPE:
735
ADDRESS:43418 62ND STREET WESTTELEPHONE:
(661) 433-0625
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:4CENSUS: 4DATE:
09/22/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Asilia Wauls - Licensee TIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents not allowed to have private conversations with other residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/19/2022, Licensing Program Analyst Melissa Ruiz (LPA) arrived at the facility to conduct an unannounced complaint visit. The purpose of this visit, is to add additional information related to this complaint. Upon arrival, LPAs were greeted by staff and LPAs later met with Licensee, Asilia Wauls. It was alleged that clients are not allowed to have private conversations with other clients. To investigate this allegation, interviews were conducted with the Licensee, two (2) staff members and two (2) out of four (4) clients. Interviews with the licensee and facility staff revealed that the facility has no restrictions when clients want to communicate with one another, they just ensure clients are being safe, by monitoring them. However, an interview with C2, revealed that fairly recently, C1 periodically tries to come into C2’s private bedroom and have private conversations multiple times. C2 stated that sometimes, C2 does not want to talk. C2 stated they have brought this issue up to facility staff, as C2 does not want to be constantly bothered by C1. An interview with C1 revealed that anytime they want to speak with other clients, they can do so with no restrictions. Based on interviews conducted, this allegation is unsubstantiated at this time. No deficiencies issued at this time. Report signed and delivered.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
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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