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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610132
Report Date: 03/11/2022
Date Signed: 03/11/2022 12:07:48 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
01/20/2022 and conducted by Evaluator Melissa Ruiz
COMPLAINT CONTROL NUMBER: 31-AS-20220120121454
FACILITY NAME:REM CALIFORNIA LLC - 27TH STREETFACILITY NUMBER:
197610132
ADMINISTRATOR:DAY, DANSHELLEFACILITY TYPE:
735
ADDRESS:43778 27TH STREET WESTTELEPHONE:
(818) 363-3333
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:4CENSUS: 4DATE:
03/11/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Amparo Murvin TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Resident was inappropriately touch by a staff member.
INVESTIGATION FINDINGS:
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At 11:00 a.m. Licensing Program Analyst (LPA) Melissa Ruiz arrived at the facility to conduct any unannounced subsequent complaint visit. LPA met with the Program Director, Amparo Murvin and explained the purpose of the visit. It was alleged that a resident was inappropriately touched by a staff member.

On 1/28/22, LPA’s Melissa Ruiz and Shira Stamps conducted an initial 10-day visit to investigate the allegation mentioned above. On this date, requested files and documents pertinent to this investigation. LPAs also conducted interviews with three (3) out of three (3) clients, four (4) staff, and the Administrator.

Interviews conducted with four (4) staff reveal that staff are prohibited from ever being alone with a client, there must always be two staff always present. This policy also applies to outings outside of the facility. Staff state that this is a policy that has always been enforced by the facility. Additionally, no staff have witnessed or heard of any other staff that may have touched a resident inappropriately. According to staff interviews, C1 has had an increase in behavior episodes in which she verbally threatens staff, and C1 threatens to make up lies.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
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 2
Control Number 31-AS-20220120121454
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 - 27TH STREET
FACILITY NUMBER: 197610132
VISIT DATE: 03/11/2022
NARRATIVE
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Interviews conducted with the clients reveal that they have observed C1’s behavior is increasingly becoming more problematic and disrespectful. Two (2) out of three (3) clients stated they have never witnessed a staff inappropriately touch a client or have experienced a staff inappropriately touch them.

Based on interviews conducted, there is insufficient evidence to support the allegation that a resident was inappropriately touched by a staff member. Therefore, the allegation is unsubstantiated. Exit interview conducted, a copy of this report was signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2