197610099-12-31-2021-31-AS-NMAN-CBC2EU-20220204162030

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610099
Report Date: 12/31/2021
Date Signed: 12/31/2021 12:54:05 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
11/09/2021 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20211109082703

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:	12/31/2021
		UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Oscar Chavez, Asst. Admin.		TIME COMPLETED:	12:48 PM

ALLEGATION(S):

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Staff did not assist resident with medications as needed.
Staff did not assist in arranging for medical care appropriate to the conditions and needs of resident.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility. Upon entry, LPA was offered sanitizer, screened for COVID 19, and signed in. LPA met with the Assistant Administrator, Oscar Chavez.

----Staff did not assist resident with medications as needed.
It was alleged that staff have not obtained prescriptions since resident #1 (R1) has been at the facility. To investigate these allegations, on 11/16/21 at 2:00pm, LPA spoke with staff and residents. In addition, at 3:00pm LPA requested and reviewed R1’s facility files and other relevant documents. The documents show that the facility did in fact assist with obtaining medication and that R1 attempted to pick up medication that was not yet due for a refill.
Based on the information revealed from interviews and records, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.
(CONT. on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021

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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Control Number 31-AS-20211109082703

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: 12/31/2021

NARRATIVE

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----Staff did not assist in arranging for medical care appropriate to the conditions and needs of resident.
It was alleged that staff have not scheduled any doctor’s appointments for R1 to be seen. To investigate these allegations, on 11/16/21 at 2:00pm, LPA spoke with staff and residents. In addition, at 3:00pm LPA requested and reviewed R1’s facility files and other relevant documents. Facility reported that R1 had a doctor’s appointment scheduled for 10/19/2021 at 10:00am, documents show that transportation arrangements were made, but R1 refused to provide the doctor’s address and phone number. The pain management doctor that R1 was attempting to see was not the Primary Care Physician and unknown to the facility. An incident report that was filed prior to the complaint is consistent with what was reported during the investigation.
Based on information from interviews and records, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards were noted during the visit.

Exit interview was conducted and a copy of the report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021

LIC9099 (FAS) - (06/04)

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