197610099-4-3-2023-31-AS-MVAO-CR9V9Z-20230426161511

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610099
Report Date: 04/03/2023
Date Signed: 04/03/2023 01:13:03 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
10/08/2021 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20211008095722

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: 55	DATE:	04/03/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Oscar Chavez		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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1. Wrongful death.
2. Facility financially abused resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness met with assistant Administrator Oscar Chavez, and informed him the reason of the visit. The following final findings of the allegations above were determined:

Allegation # 1: Wrongful death; On 10/08/2021, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding an allegation of a wrongful death. It was alleged that resident #1 (R1) was being overly medicated by facility staff, and that R1 was not able to make sound and stable decisions. R1 was transferred to the hospital, where R1 passed away.

On 10/11/2021 an initial (10-day) visit was conducted, and a physical plant tour; facility and resident records were obtained and reviewed. On the same day, LPA attempted to contact the complainant, and R1’s son; neither calls were successful and R1’s son’s phone was disconnected. On March 10, 2023 and March 16, 2023, LPA was able to connect and interview the complainant, and R1’s son from various times, from 8am to 12pm. LPA reviewed R1’s medical history and records, and after review of medication records,

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

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-20211008095722

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: 04/03/2023

NARRATIVE

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it didn't indicate that R1 passed away due to facility's neglect or mismanagement of medication. There were no discrepancies in R1’s medication records, or that the facility was over medicating R1. The death report was sent to LPA on 01/23/2023 by the Administrator. Upon review of the death certificate, and R1’s medical history, R1 cause of death was due to severe medical issues, without any other contributing diagnosis. Based on the information obtained, there is insufficient evidence to support the allegation, therefore, it is Unsubstantiated at this time.

Allegation # 2: Facility financially abused resident: It was alleged that facility staff financially abused Resident #1 (R1). On 10/08/2021, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding an allegation of facility financially abused resident.

On 10/11/2021 an initial (10-day) visit was conducted, and a physical plant tour; facility and resident records were obtained and reviewed. On the same day, LPA attempted to contact the complainant, and R1’s son; neither calls were successful and R1’s son’s phone was disconnected. On March 10, 2023 and March 16, 2023, LPA was able to connect and interview the complainant, and R1’s son from various times, from 8am to 12pm. LPA reviewed R1’s safeguard cash resources records, and based on the information, R1 was receiving monthly allowances for personal expenses, and documentation of R1’s signature was observed. Facility staff also provided written receipts for purchases; and facility bank statements; reflecting the deposits and credits for R1. It was also reported to LPA that R1’s son and friend, often had R1’s bank card, and would withdraw money with and without the presence of R1. Therefore, based on interviews and record review, LPA does not have sufficient evidence to prove the facility financially abused resident, and the allegation is Unsubstantiated at this time.

Exit interview and copy of report provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

LIC9099 (FAS) - (06/04)

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