<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610130
Report Date: 05/16/2024
Date Signed: 05/16/2024 04:01:17 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/09/2024 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20240509145722
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:
05/16/2024
UNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Kenda Comstock- Area DirectorTIME COMPLETED:
03:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not ensure that the facility has a certified administrator
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 Licensing Program Analysts (LPAs) Mariana Agban and Michael Cava conducted an unannounced intial complaint visit for the above allegation. LPAs arrived at the facility and were granted access by staff. REM Direactor was present at the facility and shortly after Area Director Kenda Comstock arrived and explained the reason for the visit.

During the course of the investigation, interview and record review was made. At 10:05 am, LPA team conducted a physical plan tour, to ensure health and safety of the clients are protected and is in compliance with Title 22 Regulations. At 10:15 AM, LPA team requested copies of pertinent infomation which include, but not limited to Physician's Report, Appraisal Needs and Services Plan, Individual Program Plan (IPP), etc., relevent to the investigation. Between 10:20 Am- 11:00 LPAs interviewed Client 1 (C1) and three (3) staff members. LPAs also reviewed documents between 10:30am-11:00am.
(Continue on 9099 C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
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 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/09/2024 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20240509145722

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:
05/16/2024
UNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Kenda Comstock- Area Director TIME COMPLETED:
03:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not provide adequate quality of food to clients
Clients are not accorded dignity in their relationships with staff and other clients.
Facility does not provide adequate incontinent care
Facility is not maintained clean, safe, sanitary and in good repair
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Mariana Agban and Michael Cava conducted an unannounced intial complaint visit for the above allegations. LPAs arrived at the facility and were granted access by staff. REM Direactor was present at the facility and shortly after QA Kenda Comstock arrived and explained the reason for the visit.

During the course of the investigation, interview and record review was made. At 10:05 am, LPA team conducted a physical plan tour, to ensure health and safety of the clients are protected and is in compliance with Title 22 Regulations. At 10:15 AM, LPA team requested copies of pertinent infomation which include, but not limited to Physician's Report, Appraisal Needs and Services Plan, Individual Program Plan (IPP), etc., relevent to the investigation. Between 10:20 Am- 11:00 LPAs interviewed Client 1 (C1) and three (3) staff members. LPAs also reviewed documents between 10:30am-11:00am.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 31-AS-20240509145722
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 - BAIRD
FACILITY NUMBER: 197610130
VISIT DATE: 05/16/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Facility does not provide adequate quality of food to clients.
It was alleged that staff do not follow the menus and that staff serves residents canned foods warmed in the microwave. RP reports that staff do not serve residents home cooked meals. Interview with S1 and S3 revealed that staff follows facility menu, however, C1 prefer to cook his/her meals. S3 stated that C1 don't want to follow the dietitian instructions since her admission date and thus whenever staff offer C1 meals, C1 turn the meal to C2. S1 and S3 mentioned that C1 likes to go groceries shopping once or twice a week buying frozen meals and refusing facility meals. Based on information obtained the allegation deemed Unsubstantiated

Allegation: Clients are not accorded dignity in their relationships with staff and other clients.
It was alleged that staff are disrespectful to everyone. Staff denied the allegation. Interview with Clients don't cooperative the allegation with staff being disrespectful as no witness where identified. Based on information obtained the allegation deemed Unsubstantiated

Allegation: Facility does not provide adequate incontinent care
It was alleged that Client wet their bed at night, and the night staff do not wash the soiled linen. Instead, the night staff sprays the linen, uses dryer sheets, dries the linen, then gives it back to the Client. Interview with S3 denies the allegation. S3 stated that when client wets the bed at night, night staff take client to the restroom for wash up and change the bed linen. S3 also stated when there is an activity pertaining to incontinent care that would occur, staff would document onto a log what was done to provide assistance. Copies of these logs were requested for review during the investigation. Moreover, in conjunction to this complaint investigation, a physical plant inspection was made during an annual. It was observed that the beddings and linens, in use by the clients were clean and maintained, and not soiled. Based on the information obtained, there wasn't enough evidence to prove that staff do not provide adequate incontinent care. Therefore, the allegation is deemed Unsubstantiated.

Allegation: Facility is not maintained clean, safe, sanitary and in good repair
It was alleged that floor boards in client's room are sinking. In conjunction to this complaint, LPAs Agban and Cava conducted an annual visit of the facility. During the LPAs inspection, the physical plant was compliant with regulation. The furniture was in good repair. Floors and passageways were maintained, clean, and clear of obstruction. Based on this observation, the allegation is deemed Unsubstantiated.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 31-AS-20240509145722
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 - BAIRD
FACILITY NUMBER: 197610130
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2024
Section Cited
CCR
85064(b)
1
2
3
4
5
6
7
Administrator Qualifications and Duries:
All adult residential care facilities shall have a certified administrator. This requirement was not met as evidenced by: During investigation, it was revealed that although the facility has an administrator designee, this designee does not have a valid
1
2
3
4
5
6
7
As POC, the licensee will submit proof/documentation that a qualified administrator will be hired in place, or a qualified designee with a valid administrator certificate will be interim until a qualified administrator is hired.
8
9
10
11
12
13
14
administrator's certificate. This poses as a potential health and safety risk to the clients in care.
8
9
10
11
12
13
14
Type B
05/23/2024
Section Cited
CCR
85064.2(a)
1
2
3
4
5
6
7
Administrator Certification Requirements: An individual shall be a certificate holder prior to being employed as an Administrator. This requirement was not met as evidenced by: Investigation reveal that S2 does not have a valid administrator certificate, which poses a potential health & safety risk.
1
2
3
4
5
6
7
As POC, the licensee will submit proof/documentation that a qualified administrator will be hired in place, or a qualified designee with a valid administrator certificate will be interim until a qualified administrator is hired.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 31-AS-20240509145722
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 - BAIRD
FACILITY NUMBER: 197610130
VISIT DATE: 05/16/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Licensee does not ensure that the facility has a certified administrator
It was alleged that facility does not have a certified administrator since October 2023. Interviews with Staff and C1 revealed that the Administrator's last day at the facility was on or around February 28, 2024. The administrator had gone on Medical leave. Staff had mentioned that Area Director Kenda Comstock had been covering for the Administrator role while the Administrator is on leave. Based on information obtained this allegation is deemed Substantiated at this time.

Exit interview conducted, Citation issued, Appeal Rights given copy of this report delivered
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6