197610131-12-1-2023-31-AS-ERIS-CY4SFE-20231201125014

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610131
Report Date: 12/01/2023
Date Signed: 12/01/2023 12:50:21 PM

Document Has Been Signed on 12/01/2023 12:50 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 - DESERT HILLS		FACILITY NUMBER:	197610131
ADMINISTRATOR:	IBRAHIM, MOSHOOD		FACILITY TYPE:	735
ADDRESS:	8241 WEST AVENUE C-14		TELEPHONE:	(818) 415-4301
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY: 4		CENSUS: 4	DATE:	12/01/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Natalie Redmond		TIME COMPLETED:	01:00 PM

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

At 10:50 a.m. on 12/01/2023, Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced Case Management - Incident Visit. LPA met with Program Manger Natalie Redmond. LPA explained the reason for the visit. Natalie contacted Area Director Brittany Bourne and informed them licensing was at this facility. Brittany designated Natalie to sign todays report. Entrance interview conducted.

LPA along with Natalie conducted a physical plant inspection to assure the health and safety of the clients in care. LPA did not observe any health and safety issues or concerns on todays visit.

This case management visit was to follow up on an Special Incident Report (SIR), that was received by Community Care Licensing (CCL) on 11/27/23 from this facility. It was reported that while completing a separate internal investigation, the REM Quality Improvement Manager (QIM) was informed that there was a report made by Staff #2 (S2), that a Staff#1(S1) working through another agency, vendorized by North Los Angeles County Regional Center (NLACRC) hired by this facility to provide 1 on 1 care for client #1 (C1) was reportedly sleeping on C1's bed prior to June 2023. The facility launched an Internal investigation of the report made. On 12/01/2023 LPA interviewed C1 and staff with knowledge about the incident. LPA interviewed C1 today at approximately 11:13 a.m. and C1 confirmed S1 was providing 1 on 1 care at night. C1 also confirmed that S1 would sleep on C1's bedroom floor and C1 "felt bad" and gave S1 permission to sleep on their bed as long as S1 used their own blanket. According to Natalie the incident was documented and was reported to management at that time the initial report was made in June of 2023. At that time the facility contacted the agency hired to provide 1 on 1 care and requested S1 not return to the facility to provide care. Facility has not used this agency to provide care to clients and has since been able to hire Direct Care Staff. At the time of the incident the facility acted appropriately. At this time the facility self reported the incident to CCL and therefore, no citations will be issued at this time.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

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

LIC809 (FAS) - (06/04)

Page: 1 of 1