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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197610099
Report Date:
08/09/2022
Date Signed:
08/09/2022 01:59:03 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
08/03/2022
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20220803141056
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:
52
DATE:
08/09/2022
UNANNOUNCED
TIME BEGAN:
10:45 AM
MET WITH:
Oscar Chavez
TIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident wandered away from facility
Facility did not report AWOL incident
Staff will not allow resident to return to facility
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 administrator Oscar Chavez and explained the reason for this visit.
LPA conducted a physical plant tour from 10:45-11am to ensure no immediate health and safety issues were present and none were noted.
Resident wandered away from the facility
It is alleged that resident #1 (R1) wandered away from the facility due to staff not watching R1. LPA conducted interviews with the administrator from 11-11:30am and the hospital from which R1 was discharged from to the facility. Information from interviews reveal that R1 was discharged from Mission Community Hospital on 8/1/22 to this facility. Upon arriving to the facility R1 decided they did not want to stay at the facility and left the facility. R1 was not in the facility for twenty minutes before they left the facility. Facility staff attempted to get R1 to stay but R1 refused. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time. Facility staff could not prevent R1 from leaving the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME
:
Cassandra Harris
LICENSING EVALUATOR NAME
:
Wendell Smith
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/09/2022
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-20220803141056
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:
08/09/2022
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
Facility did not report AWOL incident
It is alleged that the facility did not report the AWOL incident to licensing or the law enforcement. LPA interviewed the administrator in addition to checking to see if an incident report was received regarding R1 leaving the facility from 11:30-12pm. LPA found that an incident report was sent in to Community Care Licensing regarding R1 leaving the facility and that law enforcement was also contacted regarding R1 leaving the facility on 8/3/22. Based on the information obtained through interview and record review this allegation is deemed Unsubstantiated at this time.
Staff will not allow resident to return to facility
It is alleged that the facility refuses to accept R1 back from the hospital. LPA conducted an interview with the administrator and hospital staff regarding this allegation. Information from interviews reveal that Verdugo Hills Hospital wants to discharge R1 to the facility but that R1 still does not want to come back to the facility. Administrator stated they would accept R1 back to the facility if they wanted to come back but they can't force R1 to come back if they don't want to be at the facility. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.
Exit interview conducted. Copy of report issued.
SUPERVISORS NAME
:
Cassandra Harris
LICENSING EVALUATOR NAME
:
Wendell Smith
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/09/2022
LIC9099
(FAS) - (06/04)
Page:
2
of
2