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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610130
Report Date: 09/12/2024
Date Signed: 09/12/2024 03:34:14 PM

Document Has Been Signed on 09/12/2024 03:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:REM CALIFORNIA LLC - BAIRDFACILITY NUMBER:
197610130
ADMINISTRATOR/
DIRECTOR:		FREEMAN, ELIZABETHFACILITY TYPE:
735
ADDRESS:10426 BAIRD AVETELEPHONE:
(818) 363-3333
CITY:NORTHRIDGESTATE: CAZIP CODE:
91326
CAPACITY: 4CENSUS: 2DATE:
09/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:54 PM
MET WITH:Jonathan WattsTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced CASE MANAGEMENT-INCIDENT visit to this facility and met with Area Director, Kenda Comstock and Administrator Jonathan Watts. On September 3, 2024, Community Care Licensing (CCL) received a Special Incident Report (SIR) and Report of Suspected Dependent Adult/Elder Abuse (SOC 341) from Area Director Kenda Comstock reporting a sexual assault incident. On 09/01/24 at 7:00 PM, C1 had asked the Administrator to visit a friend. Administrator reminded C1 regarding the visitation policy and asked C1 to provide C1's friend's address and contact information. C1 provided the information and requested transportation. C1 was advised to check in with the Administrator upon arrival and every 30 minutes. At 9:53 PM, C1 called Administrator requesting a ride back to the facility. Administrator noticed that C1 doesn't sound well. At 10:44 PM C1 arrived at the facility and stated that they were sexually assaulted. Administrator called LAPD to report the incident and C1 was taken to Northridge Hospital to be examined. During today's visit, interviews were conducted with the facility Administrator and Area director. LPA was informed that C1 is currently at the hospital and will be discharged tomorrow. LPA conducted a file review for all clients and obtained copies of C1's physician report, admission agreement, hospital records, SOC 341, and the case number from LAPD's report. No deficiencies are cited during today's visit.

Exit Interview Conducted / A Copy of the Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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