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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610126
Report Date: 06/14/2024
Date Signed: 06/14/2024 03:56:06 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
07/21/2023 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20230721082907
FACILITY NAME:LAUREL HOMEFACILITY NUMBER:
197610126
ADMINISTRATOR:YOLANDA PICKENSFACILITY TYPE:
737
ADDRESS:41447 W 25TH STREETTELEPHONE:
(661) 947-9612
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:4CENSUS: 4DATE:
06/14/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Alex EspinozaTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not lock up cleaning supplies at the facility
Staff did not maintain complete medical records on residents in care.
INVESTIGATION FINDINGS:
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On 6/14/2024 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth was greeted by the caregivers. The Asst. Administrator Alex Espinoza arrived at 12:40 pm. LPA Spaeth stated the purpose of the visit was to tour the facility and request additional documentation.

LPA Spaeth toured the facility with the caregiver at 12:10 pm until 12:30 pm. LPA did not observe any safety issues during the tour.

The investigation consisted of the following: On 7/27/2023 LPA Spaeth initiated a complaint investigation. LPA toured the physical plant and requested documentation be sent to LPA Spaeth via email. LPA Spaeth received the documentation on 7/28/2023.

Cont'd on 809-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
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 3
Control Number 31-AS-20230721082907
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LAUREL HOME
FACILITY NUMBER: 197610126
VISIT DATE: 06/14/2024
NARRATIVE
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The investigation revealed the following: Regarding the allegation, Staff did not lock up cleaning supplies at the facility. It’s being alleged that excess hand sanitizer was stored in the living room and it was recommended to be locked in a cabinet. During LPA’s tour of the facility as of today at 12:10 pm, LPA Spaeth did not observe hand sanitizer stored in the living room area. At 12:50 pm, LPA observed the access hand sanitizer was securely stored in a locked closet.

Regarding the allegation, Staff did not maintain complete medical records on residents in care, its being alleged that resident’s immunization records were not present in the residents’ files. During today’s visit, LPA Spaeth received copies of three (3) out of the four (4) clients' immunization records (C1, C2, anc C3). The Asst. Administrator stated C4's family will provide the immunization records to the facility and the Asst. :Administrator will forward the documents to LPA Spaeth.

Based upon LPA’s observations and review of residents’ records, the above allegations are unsubstantiated.

Exit interview conducted and a copy of the report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3