197610099-4-24-2024-31-AS-TAGD-D6YTVQ-20240708150418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610099
Report Date: 04/24/2024
Date Signed: 04/24/2024 01:59:47 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
08/18/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230818155055

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: 51	DATE:	04/24/2024
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Oscar Chavez - Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff is charging residents to take a shower

Staff left residents in a soiled diaper for a long period of time

Staff did not administer medications to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with administrator Oscar Chavez and explained the reason for the visit.

LPA conducted physical plant tour at 9:35 AM, requested copies of facility documents relevant to the investigation at 10:02 AM and interviewed staff and residents between 10:30 AM to 12:30 PM. Regarding the allegation that Staff is charging residents to take a shower, it was alleged that Staff #1 (S1) charges residents to give showers. LPA's interview with six (6) residents who needs shower assistance on 08/24/23 between 11:00 AM to 1:45 PM and additional three (3) residents who also needs shower assistance on 01/11/24 between 10:34 AM to 1:00 revealed that nine (9) out of nine (9) residents interviewed denied paying S1 or any of the staff for their showers.

(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

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-20230818155055

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: WYNGATE VILLA GARDENS	FACILITY NUMBER: 197610099
	VISIT DATE: 04/24/2024

NARRATIVE

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(continued from LIC 9099)

LPA's interview with S1 on 08/24/23 at 11:34 AM revealed that S1 never asked any residents for payment when assisting them with their showers nor witnessed or have knowledge of any staff charges any resident to give them showers. LPA's interview with the administrator today at 12:00 PM also revealed that he did not receive any report of S1 or any staff of charging any resident for showers.

Regarding the allegation that Staff left residents in a soiled diaper for a long period of time, it was alleged that residents (no particular resident was identified on the complaint) are left with soiled diapers for four (4) to five (5) hours. LPA's interview with three (3) incontinent residents on 08/24/23 between 11:00 AM to 1:45 PM, one (1) incontinent resident on 01/11/24 between 10:34 AM to 1:00 and three (3) additional incontinent residents today between 10:30 AM to 12:30 PM revealed that all seven (7) incontinent residents interviewed stated that staff always change their diapers on time three (3) to four (4) times a day and staff always come within reasonable time or within (15) minutes or less when they push their call button.

Regarding the allegation that Staff did not administer medications to residents, it was alleged that S1 did not give residents their medication. LPA's interview with the administrator today at 12:00 PM revealed S1 or any caregiver do not administer medication to any resident, only the medication technician. LPA's interview with S1 today at 12:30 PM revealed that S1 never once administer or provided any medication to any resident at any time. LPA's interview with six (6) residents today between 10:30 AM to 12:30 PM. revealed that six (6) out of six (6) residents interviewed confirmed that S1 did not administer or gave them any medication at any time.

Based on the information gathered during this and prior visits, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

LIC9099 (FAS) - (06/04)

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