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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197610099
Report Date:
12/20/2021
Date Signed:
12/20/2021 02:25:05 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
12/16/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20211216134633
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:
53
DATE:
12/20/2021
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Alma Espinal
TIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to administer resident's medication as prescribed
Staff failed to safeguard resident's personal belongings
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit.
LPA took a tour of the physical plant area to ensure no immediate health and safety issues from 10:10am-10:20am. No immediate health and safety issues were noted.
Staff failed to administer resident's medication as prescribed
It is alleged that facility did not administer resident # 1 (R1) medication as R1 was supposed to get it. LPA conducted an interview with R1 from 10:45am-11:15 am regarding the complaint allegations. LPA interviewed the administrator regarding this allegation from 10:20-10:40am. LPA also reviewed R1's facility file and obtained copies of pertinent information from 11:15am-11:45am. Information revealed that R1 refused to take their insulin medication but that facility did offer R1 their insulin medication. Administrator stated they contacted R1's physician and let him know about it. Based on the information obtained through interviews and record review this allegation is deemed Unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME
:
Cassandra Harris
LICENSING EVALUATOR NAME
:
Wendell Smith
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/20/2021
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-20211216134633
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:
WYNGATE VILLA GARDENS
FACILITY NUMBER:
197610099
VISIT DATE:
12/20/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Staff failed to safeguard resident's personal belongings
It is alleged that R1's belongings were stolen from them at the facility. LPA conducted interviews with R1 and the administrator regarding this allegation. LPA also reviewed incident reports that was submitted to licensing regarding this allegation. Interviews revealed that R1 did lose some of their personal belongings but that it did not happen at the facility but while R1 was out in the community. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.
Exit Interview conducted.
SUPERVISORS NAME
:
Cassandra Harris
LICENSING EVALUATOR NAME
:
Wendell Smith
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/20/2021
LIC9099
(FAS) - (06/04)
Page:
2
of
2