197610099-3-6-2023-31-AS-NMAN-CPRMK5-20230309084009

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610099
Report Date: 03/06/2023
Date Signed: 03/06/2023 12:37:30 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
11/04/2022 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20221104160936

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:	DATE:	03/06/2023
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:			TIME COMPLETED:	12:41 PM

ALLEGATION(S):

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Staff left resident in soiled diaper for extended period of time

INVESTIGATION FINDINGS:

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This is to amend the report that was delivered on 11/21/2022.
Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to this facility to investigate the above allegation. LPA met with Ricardo Rodriguez, who was designated by the Administrator to accept this report, and explained the reason for the visit.

---Staff left resident in soiled diaper for extended period of time
It was alleged that Staff #1 (S1) was the only staff on duty and did not change Resident #1 (R1) timely due to the Administrator’s instructions for S1 to stay away from R1. To investigate the allegation on 11/14/2022 at 9:30 AM, LPA made observations during a physical plant tour, at 10:00 AM, LPA requested documents, from 10:15 AM – 10:45 AM, LPA interviewed other parties, from 10:50 AM – 11:50 AM, LPA randomly selected and interviewed at least 10% of the residents present at the facility, and from 12:00 PM – 1:00 PM, LPA interviewed staff.
(Cont. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

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-20221104160936

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: 03/06/2023

NARRATIVE

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During observation, LPA did not experience any malodor and residents were clean and well groomed. A review of the facility’s records shows that there are two staff assisting residents during the morning, afternoon and overnight shifts.

During interviews with other parties, they stated that S1 declined to assist with incontinent care and that S1 was instructed by the Administrator not to assist R1. R1 admitted to throwing liquids that hit S1, but that it was inadvertent, and did not refuse assistance from Staff #4 (S4). During interviews with other residents, they stated that staff change them often, or as needed, and staff have never refused services. During interviews with S1, they stated that R1 threw something at them, did not feel safe with R1 and was instructed by the Administrator not to deal with R1. S1 also stated that S4 was on duty that day and R1 refused services from S4. All remaining staff stated that the residents are changed frequently, they are checked on at least every two hours, that residents are not left without a change in diapers for an extended period of time and do not refuse incontinent services.

Based on interviews, there is not enough information to verify the allegation, therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards observed during the visit.

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

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC9099 (FAS) - (06/04)

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