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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610089
Report Date: 12/28/2023
Date Signed: 12/28/2023 03:50:55 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
06/01/2023 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20230601091518
FACILITY NAME:FT. KNOX SUPPORTIVE HOUSING INC.FACILITY NUMBER:
197610089
ADMINISTRATOR:WILLIAMS, LAVEARNFACILITY TYPE:
735
ADDRESS:288 W TERRACE STTELEPHONE:
(323) 386-1387
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY:4CENSUS: 3DATE:
12/28/2023
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Latonda Knox, Administrator TIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff consumed alcohol while on shift
Staff does not treat client with respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Panushkina, conducted a subsequent visit to deliver final finding. LPA met with the Administrator and explained the reason for the visit.

At 10:10 AM, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations

During the initial visit made on 06/08/23, LPA Panushkina met with the Administrator and requested client and staff roster. At 10:00 AM, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Individual Program Plan, Preplacement Appraisal Information, relevant to the investigation. Between 10:40 AM – 11:45 AM, LPA conducted an interview with the Administrator and one (1) staff member. LPA was unable to interview the clients due to three (3) out of four (4) clients being at the Day Program.
Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023
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-20230601091518
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: FT. KNOX SUPPORTIVE HOUSING INC.
FACILITY NUMBER: 197610089
VISIT DATE: 12/28/2023
NARRATIVE
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On 06/09/23, LPA contacted two (2) staff members and three (3) out of four (4) clients to obtain more information regarding both allegations.

Allegation: Staff consumed alcohol while on shift

It was alleged that Staff consumed alcohol while on shift. Interviews conducted with three (3) out of four (4) clients, revealed that no staff consumed any alcohol while on shift. All three (3) clients denied the above allegation and expressed no concerns. Moreover, interview with the Administrator revealed that the facility staff is not allowed to use any type of alcohol while on shift. Lastly, all staff members informed LPA that such unprofessional behavior is not acceptable at the facility. Based on information obtained through interviews this allegation is deemed Unsubstantiated.

Allegation: Staff does not treat client with respect

To investigate this allegation, LPA conducted an interview with the Administrator and three (3) staff members and was informed that the staff always takes care of all clients with dignity and respect. LPA was also informed that facility conducts monthly meetings with all staff regarding the basic services, personal rights, mandated reporter, ect. LPA conducted review of all training documents and confirmed the training is being conducted and completed during the monthly meetings. In addition, three (3) out of four (4) interviewed clients indicated that the facility staff always treats them with respect and they do not have any concerns regarding this allegation. Based on information obtained through interviews there is not enough sufficient evidence to support the allegation. Therefore, the allegation is Unsubstantiated at this time.

No deficiencies cited during todays visit.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2