197610099-10-7-2021-31-AS-CHAS-C92VRX-20211123154041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610099
Report Date: 10/07/2021
Date Signed: 10/07/2021 02:59:46 PM

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
10/01/2021 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20211001123510

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: 54	DATE:	10/07/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kristine Juarez & Oscar Chavez		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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1. Facility is dirty
2. Facility phone does not work
3. Residents smoking in non-designated smoking areas of facility
4. Staff did not seek medical attention in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced initial complaint visit for the allegations mentioned above. LPA arrived at the facility and met with medication technician Oscar Chavez, who was informed the reason of the visit. Oscar, contacted Administrator Alma Espinal, who LPA spoke with and also informed the reason of the visit. Licensee Kristine Juarez arrived to the facility at 1045am, and LPA informed her the reason of the visit. Administrator Alma Espinal arrived at 1pm. From 10am to 2pm, LPA reviewed facility and client records, conducted interviews, and completed a physical plant inspection. The following was determined:

Allegation # 1: Facility is dirty. Concerns were expressed that the bathroom sink and toilet was filthy, and had spider webs. During the physical plant inspection, LPA observed the common areas to be clean, such as resident rooms, bathroom, and kitchen area. LPA also

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

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-20211001123510

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: 10/07/2021

NARRATIVE

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observed housekeepers cleaning various areas at the facility. Although it was reported that the facility was dirty, based on today's observations, LPA did not find evidence the facility was dirty, and the allegation is UNSUBSTANTIATED at this time.

Allegation # 2: Facility phone does not work. During today's inspection, at 10:30am, LPA contacted the facility phone number, and staff answered the phone. LPA was informed, that on 09/28/2021, the facility's mother board for telephone service, stopped functioning, and the facility was not receiving incoming calls. The telephone company was contacted for repair, and it was fixed. LPA was also informed that the facility has (2) other phone lines; (1) telephone line for residents, and another business line, that is for Administration. Although, the phone was not working for a specific day, the facility had other operating telephone service for emergencies. The Licensee informed LPA, that she will include the other (2) operating lines on there website, and provide it to others, such to family and business contacts. Therefore, based on the information obtained during today's visit, and the facility phone was not working, the allegation is UNSUBSTANTIATED at this time.

Allegation # 3: Residents are smoking in non-designated smoking areas. During today's physical inspection and observations, LPA observed several areas where residents were smoking: front, side, and in the back of the facility. According to interviews conducted, Administration has designated several areas for residents to smoke. Although Administration prefer residents to smoke in the back of the facility, LPA was informed, that residents are allowed to smoke anywhere outside of the facility; but not allowed to smoke in there rooms, or inside common areas in the facility. Administration has chosen to allow residents to secure there own cigarettes and smoke at there own free will; but outside. Therefore, the allegation, residents are smoking in non-designated smoking areas, is UNSUBSTANTIATED.

Allegation # 4: Staff did not seek medical attention in a timely manner. During today's interviews, it was reported staff was not checking resident's oxygen levels. Through information, obtained, LPA was informed that there were no medical concerns, and the allegation mentioned was written in error, and the allegation is UNSUBSTANTIATED at this time. Exit interview and copy of report provided

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

LIC9099 (FAS) - (06/04)

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