197610130-3-10-2023-31-AS-NMAN-CQMVUN-20230406164502

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610130
Report Date: 03/10/2023
Date Signed: 03/10/2023 02:30:37 PM

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
02/09/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230209142504

FACILITY NAME:	REM CALIFORNIA LLC - BAIRD		FACILITY NUMBER:	197610130
ADMINISTRATOR:	FREEMAN, ELIZABETH		FACILITY TYPE:	735
ADDRESS:	10426 BAIRD AVE		TELEPHONE:	(818) 363-3333
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91326
CAPACITY:	4	CENSUS: 3	DATE:	03/10/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Elizabeth Freeman - Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff kicked resident

Resident eloped from facility

An altercation occurred in the facility

Resident's personal item was confiscated

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent visit at this facility to further investigate the above allegation. LPA met with Administrator Elizabeth Freeman and explained the reason for the visit.

LPA conducted physical plant tour at 9:10 AM, requested copies of facility document relevant to the investigation at 9:32 AM and conducted staff interview between 10:12 AM to 12:30 PM. LPA also conducted record review between 12:30 PM to 2:00 PM. Regarding the allegation that staff kicked resident, It was alleged that staff kicked Resident #1 (R1) in the shin. LPA's interview with staff on 02/14/23 between 1:00 PM and 2:25 PM and today between 10:12 AM to 12:30 PM, revealed that no staff kicked R1 nor witness any staff kicked R1 at any time. LPA's record review today between 12:30 PM to 2:00 PM also revealed that R1 had a history of tantrums, destruction of property, aggression towards staff and other residents and fabrication of untrue stories.

(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230209142504

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: REM CALIFORNIA LLC - BAIRD	FACILITY NUMBER: 197610130
	VISIT DATE: 03/10/2023

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that Resident eloped from facility, it was alleged that R1 eloped at the facility on 01/21/23, LPA's record review revealed that there was an R1 ran out of the facility at the height of R1's tantrum episode wherein R1 ran away when R1 did not get the attention of the staff. LPA's interview with staff revealed that the staff tried to stop R1 from leaving but ran away from the facility, staff immediately followed R1 but R1 hid inside the pharmacy and grocery stores in the nearby strip mall. 911 was called to assist and the staff kept on shadowing R1 at all time until R1 was back at the facility. R1 was back in the facility in less than two (2) hours from the time R1 left and apologized to the staff.

Regarding the allegation that an altercation occurred in the facility, it was alleged that R1 had an altercation with the staff that led R1 to leave the facility. LPA's interview with staff on 02/14/23 between 1:00 PM and 2:25 PM and today between 10:12 AM to 12:30 PM revealed no staff had any altercation with R1 it was only R1 who yelled and threatened staff. LPA's record review today between 12:30 PM to 2:00 PM also revealed that R1 had a history of tantrums, destruction of property, aggression towards staff and other residents and fabrication of untrue stories..

Regarding the allegation that Resident's personal item was confiscated, it was alleged that R1's toy water gun was taken by the staff, LPA's interview with staff today between 10:12 AM to 12:30 PM revealed that no one confiscated R1's toy gun but R1 broke own toy gun after R1 was told to stop shooting water to the staff. R1 moved to the couch and broke own water toy gun.

Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

LIC9099 (FAS) - (06/04)

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