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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610088
Report Date: 07/02/2024
Date Signed: 07/02/2024 02:19:38 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
05/04/2023 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20230504125125
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:
07/02/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Chary HallonTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff are financially abusing client.
INVESTIGATION FINDINGS:
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On 07/02/24 Licensing Program Analyst (LPA) Evelin Rios conducted a subsequent unannounced complaint visit to deliver findings for the above allegation. LPA arrived at the facility at 12:00 p.m. and was greeted by staff#1 (S1). S1 called the administrator, Chary Hallon. The licensee, Dolly Wauls called the facility and spoke with LPA. LPA explained the purpose of the visit. Administrator met LPA shortly after.

At 12:18 p.m. LPA conducted a physical plant tour to ensure the health and safety of the clients in care. No issues or concerns were observed.

Allegation: Staff are financially abusing client.
It is alleged staff mismanaged Client #1’s (C1s) personal and incidental (P&I) funds. To investigate the allegation, an initial visit was conducted by LPA Rios on 05/09/23.
(Cont. to LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
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 2
Control Number 31-AS-20230504125125
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: TIGERTAIL ADULT HOME 4, INC.
FACILITY NUMBER: 197610088
VISIT DATE: 07/02/2024
NARRATIVE
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On 5/09/2023 at 12:45 p.m., LPA Rios arrived at the facility and met with Maria Ramos the House Manager at the time, LPA explained the reason for the visit. At approximately 12:46 p.m. LPA conducted an entrance interview via telephone with Administrator Chary Hallon. While touring the facility LPA conducted an interview with client #1 (C1) and attempted interviews with two (2) other clients who did not respond to LPAs questioning.

On 05/09/2023 LPA reviewed current Record of Client’s Safeguarded Cash Resources (LIC 405) along with receipts and total cash for three (3) out four (4) clients. No discrepancies noted. LPA requested, the administrator send LPA copies of clients' documents relevant to this investigation such as LIC 405 and receipts for the year 2022, most current Individual Program Plan (IPP), admission agreements and Client Personal Property and Valuables (LIC621). LPA reviewed Record of Client’s Safeguarded Cash Resources (LIC 405), and receipts for three (3) of four (4) clients the facility is responsible for handling all cash resources. LPA reviewed receipts and ledgers (LIC405) from June 28, 2022 to April 11, 2023. LPA did not observe receipts for ticket purchases for Six Flags or Disneyland. LPA did not observe a purchase for tickets signed by client and according to records and administrator staff sign LIC405 and not the client. LPA’s interview with C1 revealed they have not been to Six Flags in years and remembers going when they were under 18 years old. Interview with Licensee and administrator revealed that C1 can become confused and may forget events that occurred or make up events that have not occurred. Review of C1’s IPP corroborates client engages in making false allegations and will make statements about peers that are not true. On 07/02/24, interview with administrator and licensee deny the allegation. LPAs review of LIC405 revealed increments of $50 is provided directly to C1's day program to make purchases. According to administrator, facility staff are provided cash when out with C1 to make purchases for C1 and a receipt is turned in to balance LIC405. C1's, IPP revealed C1 has no concept of money management/denominations of bills and coins and is unable to manage their money. Further investigation into C1's admission's agreement for this facility revealed client had previously lived in Tigertail Adult Home II and moved to Tiger Tail Adult Home 4 effective June 28 2022. According to Chary and emails between North Los Angeles County Regional Center, Service Coordinator Sonia Corrillo, confirms regional center was aware of transfer and is working to update required documentation such as admission agreement to Tiger Tail Adult Home 4.



Based on interviews conducted and record review, there is insufficient evidence to support the allegation that staff are financially abusing client. Therefore, the allegation is Unsubstantiated at this time. Exit interview conducted, a copy of this report was signed and delivered.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC9099 (FAS) - (06/04)
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