197610137-10-6-2021-31-AS-EMIR-C8MT5D-20211110132522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610137
Report Date: 10/06/2021
Date Signed: 10/06/2021 02:55:51 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
10/01/2021 and conducted by Evaluator Alexander Pitz

COMPLAINT CONTROL NUMBER: 31-AS-20211001091517

FACILITY NAME:	REM CALIFORNIA LLC - OSBORNE		FACILITY NUMBER:	197610137
ADMINISTRATOR:	IBRAHIM, MOSHOOD		FACILITY TYPE:	735
ADDRESS:	15952 OSBORNE ST		TELEPHONE:	(818) 893-1234
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	4	CENSUS: 3	DATE:	10/06/2021
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Adeleye Sotimehin		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff do not assist resident with obtaining medical care
Staff interfere with resident's phone calls
Staff do not communicate with responsible party regarding resident's care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pitz conducted an unannounced visit on this day in response to the above allegations.

During this investigation, LPA interviewed the complainant telephonically on 10/4/21; interviewed the North Los Angeles County Regional Center (NLACRC) caseworker for Client 1 (C1) on 10/6/21 at 1:43 pm; conducted a visit to the facility to review client records, attempt interviews with 3/3 clients and 4/4 staff present on 10/6/21 at 1:30pm.

Allegation #1, that “staff do not assist resident with obtaining medical care,” has been unsubstantiated based on the interviews conducted and records reviewed. Neither C1’s NLACRC caseworker, the facility staff interviewed, nor C1 was able to corroborate this allegation. All denied that C1 was experiencing any symptoms of allergies or that he had any other known, unmet medical needs. The complainant was unable to provide, and LPA did not observe in C1’s file, any indication otherwise.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Alexander Pitz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

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-20211001091517

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 - OSBORNE	FACILITY NUMBER: 197610137
	VISIT DATE: 10/06/2021

NARRATIVE

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Allegation #2, that “Staff interfere with resident's phone calls,” has been unsubstantiated based on the interviews conducted. None of the interviews conducted on 10/6/21 with staff or NLACRC personnel corroborated this allegation. C1 denied having their access to the phone restricted, and the complainant did not provide any additional corroborating evidence to support the allegation.

Allegation #3, that “Staff do not communicate with responsible party regarding resident's care,” has been unsubstantiated based on the records reviewed and interviews conducted. The file review conducted by LPA on 10/6/21 at 1:30pm confirmed that C1 is not conserved and has signed their admission agreement and physician’s report as their own responsible party. The complainant did not provide any evidence to corroborate that they are the legal responsible party for C1, nor did the complainant provide any specific examples of the facility failing to report medical care. All 4/4 staff interviewed on 10/6/21, as well as the NLACRC caseworker for C1, stated that they were not aware of any incidents or appointments that had not been communicated to C1’s family.

Report reviewed, signed and delivered. Exit interview conducted, no deficiencies cited.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Alexander Pitz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

LIC9099 (FAS) - (06/04)

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