197610130-6-4-2024-31-AS-EMIR-DKWV5Q-20250826160811

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610130
Report Date: 06/04/2024
Date Signed: 06/04/2024 03:43:08 PM

Unsubstantiated

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
05/28/2024 and conducted by Evaluator Mariana Agban

COMPLAINT CONTROL NUMBER: 31-AS-20240528120602

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:	06/04/2024
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Idris Danesi - Rem Director		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Staff did not prevent a client from causing self harm
Staff threatened a client
Staff do not have planned activities for a client
Staff make inappropriate comments towards a client

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced initial complaint visit for the above allegations. LPAs arrived at the facility and were granted access by staff. REM Director Idris Danesi was present at the facility and explained the reason for the visit. LPA was informed that Administrator Designee Kenda Comstock could not attend today's visit due to medical emergency.

At 9:55 AM, LPA requested copies of pertinent information which include, but not limited to Physician's Report, Appraisal Needs and Services Plan, Individual Program Plan (IPP), etc., relevant to the investigation. Between 10:00 Am- 11:00 LPA interviewed Client#1 (C1) and three (3) staff members and Case Manager from Regional Center. LPA also reviewed documents between 11:00am-12:15 PM.

Allegation: Staff did not prevent a client from causing self harm
It was alleged that staff didn't deescalate a behavior episode when C1 pick up a piece of glass and attempted to cut themself. (Continue 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024

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-20240528120602

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: 06/04/2024

NARRATIVE

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Interview with S1 and S2 revealed that C1 had a behavior episode on 05/27/2024 that caused destruction to the home. C1 shattered a glass table and picked up a piece of the broken glass and then walked in the room and locked the door attempting to hurt themself. S2 had asked multiple times C1 to unlock the door but C1 didn't. S1 called 911 and the LAPD asked everyone in the facility to evacuate. C1 was transported to the Northridge hospital. Based on information obtained, the allegation deemed Unsubstantiated at this time.

Allegation: Staff threatened a client
It was alleged that staff had threatened C1. Staff denied the allegation. Interview with C1 did not cooperate with the allegation as no witnesses were identified. Based on the information obtained the allegation is deemed Unsubstantiated at this time

Allegation: Staff do not have planned activities for a client
It was alleged that staff prevented C1 from activities. According to the Special Incident Report (SIR) sent to CCL on 05/29/24, staff had planned to take C1 to the beach, however, due to the behavior episode it was rescheduled for C1's safety. Administrator designee had advised staff to change the plan, and engage C1 in activities at the house for safety. Based on information obtained, the allegation is deemed Unsubstantiated at this time.

Allegation: Staff make inappropriate comments towards a client
It was alleged that staff have been making inappropriate comments, and calling the C1 names. S1 and S2 denied the allegation. Interview with C1 did not cooperate with the allegation as there are no witnesses were identified. Based on information obtained the allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of this report delivered.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024

LIC9099 (FAS) - (06/04)

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