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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610130
Report Date: 10/30/2024
Date Signed: 10/30/2024 04:35:32 PM

Document Has Been Signed on 10/30/2024 04:35 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:
10/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:24 PM
MET WITH:Kenda ComstockTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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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. 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 suspected physical abuse. On 09/25/24 reported to Area Director, Kenda Comstock that during the behavior episode on 09/14/24 C1 was lifted off their back by S1 who attempted to remove the stepping stone from C1. Interview with S1 denied the allegation. S1 stated that they had only leaned forward to grab the stepping stone from C1 without touching C1. Interview S2 denied the allegation stating that S1 was only pulling the stepping stone from C1. Based on information obtained there are no deficiencies cited during today's visit as there was no sufficient evidence of physical abuse.

Exit Interview Conducted / A Copy of the Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
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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