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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610126
Report Date: 04/07/2022
Date Signed: 04/11/2022 11:12:13 AM

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
12/23/2021 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20211223105731
FACILITY NAME:LAUREL HOMEFACILITY NUMBER:
197610126
ADMINISTRATOR:STIX, ALEXANDRAFACILITY TYPE:
737
ADDRESS:41447 W 25TH STREETTELEPHONE:
(661) 947-9612
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:4CENSUS: 2DATE:
04/07/2022
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Yolanda PickensTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are not CPR/First Aide certified.
Facility does not have complete personnel files.
Facility is not following the program design.
INVESTIGATION FINDINGS:
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LPA Spaeth made an unannounced visit and was greeted by caregiver #1 who took LPA's temperature and asked the COVID questions. LPA explained the purpose of the visit was to complete the investigation which alleged staff are not CPR/First Aide Certified, faclity does not have complete personnel files, and facility is not following the design program. LPA observed all staff wearing a mask.

LPA conducted a physical plant tour from 2:20 pm until 2:35 pm with caregiver #2 to ensure no immediate health and safety issues. LPA did not observe any immediate health and safety issues. LPA was greeted by Administrator, Yolanda Pickens at 2:35 pm.

LPA reviewed nine personnel files from 2:45 pm until 3:00 LPA observed the CPR/First Aid certificates were all current. Therefore the allegations, staff are not CPR/First Aide Certified and facillity does not have complete personnel files is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
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-20211223105731
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: LAUREL HOME
FACILITY NUMBER: 197610126
VISIT DATE: 04/07/2022
NARRATIVE
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In regard to allegation facility is not following program design, LPA received clarification from North Los Angeles Regional Center that the facility's program design regarding qualifications and education, the Regional Center stated facility staff are not following the staff education requriements. LPA reviewed the program plan which states staff must obtain and maintain current certification in CPR/FA/AED prior to working. LPA observed the nine staff files contained current certifications. Therefore, this allegation is unsubstantiated.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2