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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610130
Report Date: 05/10/2024
Date Signed: 06/20/2024 05:09:11 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
10/04/2023 and conducted by Evaluator Huma Rahimi
COMPLAINT CONTROL NUMBER: 31-AS-20231004124831
FACILITY NAME:REM CALIFORNIA LLC - BAIRDFACILITY NUMBER:
197610130
ADMINISTRATOR:FREEMAN, ELIZABETHFACILITY TYPE:
735
ADDRESS:10426 BAIRD AVETELEPHONE:
(818) 363-3333
CITY:NORTHRIDGESTATE: CAZIP CODE:
91326
CAPACITY:4CENSUS: 2DATE:
05/10/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Idris Danesi, Regional DirectorTIME COMPLETED:
12:55 PM
ALLEGATION(S):
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Staff handled resident in a rough manner while in care.
INVESTIGATION FINDINGS:
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This is an Amendment to the original report issued on 05/10/2024. Additional information was added to clarify the investigation.

At 8:45 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent complaint visit. LPA observed that there is a staff, Rita Nwaego, outside of the facility and taking clients to the Day Program. Staff requested to wait until their arrival back to give access to the facility. At 9:20 AM, LPA was granted access to the facility. Shortly after the Administrator designee and LPA explained the reason for the visit.
An initial visit was conducted on 10/11/2023, by Licensing Program Analyst (LPA) Mariana Agban. During that time, LPA requested copies of pertinent information which include, but not limited to Physician’s Report, Admission Agreement, Appraisal Needs and Services Plan, IPP, etc., relevant to the investigation.
Continue on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
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-20231004124831
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: REM CALIFORNIA LLC - BAIRD
FACILITY NUMBER: 197610130
VISIT DATE: 05/10/2024
NARRATIVE
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During today's visit at 09:20 AM, LPA requested resident and staff roster. At 9:41 AM, LPA conducted a physical plant tour. LPA also requested staff training. Between 10:15 AM – 11:00 AM, LPA conducted an interview with the Administrator designee, Reginal Director, and one (1) Staff.

Staff handled resident in a rough manner while in care.
It was alleged that the staff handled client in a rough manner during a "take down". Interview with the Administrator’s designee, a Regional Director (RD) and one (1) staff revealed that on 10/04/23, C1 had a behavioral episode. During the time of the incident, the former Administrator was present at the facility and did not step in to assist and provide proper guidance to staff to handle C1. Based on the nature of the incident, on 10/05/2023, the facility conducted an internal investigation which was completed on 10/11/2023. Upon the completion of the investigation, the former Administrator and one of the Staff #1 (S1) were terminated from their positions. Furthermore, interview with Regional Director (RD), confirmed that the procedure of Professional Crisis Management (PCM), were not properly administered at the time of the incident with C1.

On 06/20/24, LPA conducted a subsequent visit to obtain a copy of a PCM Crisis Intervention Protocol and observed that during the Breakdown or Imminent breakdown the staff was supposed to follow all four steps, including step #3. Utilize non-physical strategies. However, the staff failed to follow the proper steps during the incident that occurred on 10/05/23 and handled C1 inappropriately by using physical restrain. C1 was place on the mat, facing down, while S1 was holding C1’s back and S2 was holing C1’s hands which led C1 to run out of breath. Additionally, LPA reviewed C1’s Physician’s Report and observed that C1 was diagnosed with Asthma. Based on the information obtained through interviews the allegation is deemed Substantiated.


Deficiencies cited on LIC 9099 D.
Appeal Rights explained. Exit Interview conducted.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20231004124831
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: REM CALIFORNIA LLC - BAIRD
FACILITY NUMBER: 197610130
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2024
Section Cited
CCR
85102(a)(6)
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85102(a)(6) Emergency Intervention Prohibitions: (a) The following emergency ... client:(6) Any manual restraint ....person's airway or...restricts breathing or circulation;
This requirement is not met as evidenced by:
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Administrator designee provided proper training record for all staff and agreed that staff will follow all proper procedures in case of incident as such: POC cleared during today's visit.
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Based on interviews and LPAs inspection the licensee did not comply with the section cited above. On 10/04/23, C1 had a behavior episode and S1 handle C1 in a rough manner. However, the former Administrator was present at the facility and did not step in to assist and provide proper guidance, which poses/posed a potential health and safety risk to persons in care.
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Type B
06/27/2024
Section Cited
CCR
80072(a)(1)
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80072(a)(1) Personal Rights (a)...each client shall have personal rights which include,...(1) To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as evidenced by
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Administrator agreed shall provide training to all staff regarding this section and a copy of training will be submitted to LPA by the POC due date.
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Based on interviews and record reviews licensee did not comply with the seciton cited above by not according C1 with dignity in his/her relationships with staff which poses an potential Health, Safety or Personal Rights risks to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3