197610099-10-5-2023-31-AS-TAGD-D7PL3C-20240731082344

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610099
Report Date: 10/05/2023
Date Signed: 10/05/2023 01:57:14 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
10/02/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20231002164728

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: 49	DATE:	10/05/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Oscar Chavez - Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not prevent a resident from hitting another resident while in care

INVESTIGATION FINDINGS:

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

LPA conducted physical plant tour at 9:38 AM, requested copies of facility documents relevant to the investigation at 10:02 AM and interviewed staff and residents and witness between 10:10 AM to 1:00 PM. It was alleged that Resident #1 (R1) was punched by Resident #2 (R2) in the shoulder. LPA's record review today at 10:15 AM revealed that both R1 and R2 are independent and attending Adult Health Day Center (ADHC) in Canoga Park. LPA's interview with the administrator today at 10:10 AM revealed that it was reported to him by R1 that the incident happened at the ADHC when R1 and R2 were doing activity in the ADHC and when R1 tried to assist R2 in the game, R2 allegedly hit R1. LPA's interview with the staff of ADHC today at 12:35 PM revealed that the staff did not witness any physical or verbal altercation between R1 and R2 at any time while in the day program. (continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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-20231002164728

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: 10/05/2023

NARRATIVE

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(continued from LIC 9099)

Further interview with the ADHC staff also revealed that no staff and/or client witnessed the alleged incident either per the staff's investigation.

LPA's interview with another resident which is a common friend of both R1 & R2 confirmed the story of the administrator that the incident did not happen at the facility and also revealed that R1 & R2 had an ongoing relationship. Further interview with the administrator also revealed that there was no reported incident wherein R2 had any physical or verbal altercation with R1 at any time while in the facility.

Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC9099 (FAS) - (06/04)

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