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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610126
Report Date: 10/04/2024
Date Signed: 10/04/2024 02:14:05 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
09/23/2024 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20240923110653
FACILITY NAME:LAUREL HOMEFACILITY NUMBER:
197610126
ADMINISTRATOR:ALEX ESPINOZAFACILITY TYPE:
737
ADDRESS:41447 W 25TH STREETTELEPHONE:
(661) 947-9612
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:4CENSUS: 4DATE:
10/04/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:ALEX ESPINOZATIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff choked resident in care.
INVESTIGATION FINDINGS:
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On 10/04/2024 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth met with the Administrator, Alex Espinoza. LPA explained the purpose of this visit was to deliver the findings.

The investigation consisted of the following: On 9/26/2024 LPA conducted an initial visit. LPA interviewed four out of ten staff members (S1-S4) and the Administrator at 10:40 am until 11:10 am. LPA reviewed the clients’ documents at 11:15 am until 11:40 am. LPA received copies of the client’s documents.

Regarding the allegation: Staff choked resident in care. It’s alleged that a facility staff member choked a client; however the client was unable to provide the details and unable to provide the staff member’s name.

Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024
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 2
Control Number 31-AS-20240923110653
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: 10/04/2024
NARRATIVE
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LPA reviewed the incident report dated 9/14/2024 which stated three staff members were attempting to redirect a client (C1) and a staff member was observing the incident. The report did not state staff choked a client.

S1-S4 unanimously confirmed a client (C1) was not choked during the incident. S1-S3 stated they followed the facility’s emergency prevention plan by blocking C1’s attempt to hit staff and using prevention techniques to prevent C1 from hurting themselves.

S1-S4 confirmed C1 tried to strangle themselves with a hanger and with other items. However, S1-S4 confirmed they used de-escalation verbal prompts to stop C1. S1-S4 confirmed they did not hold down C1 nor put their hands around C1’s neck. On 9/30/2024, LPA Spaeth received photos of C1 that were taken on 9/12/2024. The photos do not show any signs of red marks or bruises around C1’s neck. S1-S2 and the Administrator demonstrated to LPA two of the three techniques used. LPA observed the techniques did not include their hands wrapped around another person’s neck. LPA attempted to interview C1.

Based on the interviews conducted, the allegation is unsubstantiated.

An exit interview was conducted and a copy of the report was given.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2