197610099-7-15-2021-31-AS-NGID-C5BNEQ-20210727102416

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610099
Report Date: 07/15/2021
Date Signed: 07/15/2021 03:51:12 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
02/26/2021 and conducted by Evaluator Alexander Pitz

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20210226123234

FACILITY NAME:	WYNGATE VILLA GARDENS		FACILITY NUMBER:	197610099
ADMINISTRATOR:	ESPINAL, ALMA		FACILITY TYPE:	740
ADDRESS:	7634 WYNGATE STREET		TELEPHONE:	(818) 352-4270
CITY:	TUJUNGA	STATE: CA	ZIP CODE:	91042
CAPACITY:	68	CENSUS: 47	DATE:	07/15/2021
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Jasmine Dolores		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident not being provided medication as prescribe.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Pitz conducted an unannounced visit on this day in response to the above allegation.

As part of this investigation LPA interviewed staff #1 (S1) on 2/25/21 and resident 1 (R1) on 7/15/21 at 1:45pm. LPA also reviewed the medication assistance record (MAR) for R1 on 7/15/21 at 2:45pm.

Allegation #1, that "Resident not being provided medication as prescribe" has been unsubstantiated based on the interviews conducted and records reviewed. At 1:45pm on 7/15/21 R1 denied having any difficulty with getting their medication prescriptions filled or receiving any other necessary assistance. A review of R1's MAR at 2:45 pm did not reveal any discrepancies.

Report reviewed signed and delivered. Exit interview conducted, no deficiencies cited.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Alexander Pitz
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021

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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