197610151-7-21-2023-31-AS-MVAO-CULPPR-20230811112954

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610151
Report Date: 07/21/2023
Date Signed: 07/21/2023 01:49:39 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
02/03/2023 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20230203165134

FACILITY NAME:	AEGIS LIVING GRANADA HILLS		FACILITY NUMBER:	197610151
ADMINISTRATOR:	MATTHEW LA VINE		FACILITY TYPE:	740
ADDRESS:	10801 LINDLEY AVE		TELEPHONE:	(818) 363-3373
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	100	CENSUS: 99	DATE:	07/21/2023
		UNANNOUNCED	TIME BEGAN:	08:33 AM
MET WITH:	Matthew La Vine		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff slapped a resident

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Christopher Alemoh and Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above facility. It was alleged that on or around 01/27/23, Resident 1 (R1) was slapped by Staff 1 (S1) while R1 was getting assistance with their shower. LPAs met with the administrator, Matthew La Vine, and advised him of the complaint. Today's investigation consisted of interviews with staff and residents, record review and a physical plant inspection.

At approximately 8:45am, a physical plant observation was made to insure the health and safety of the residents. In conjunction with the physical plant inspection, interviews with the administrator and staff were made. Interviews held with the administrator and staff deny the allegation of S1 slapping R1. According to staff, it is R1 that has a history of being aggressive and combative. Interview made with R1 do not corroborate with the allegation. Moreover, R1 could not identify any witnesses to confirm that they were slapped by S1. In addtion, there were no other resident concerns regarding S1 ever being aggressive

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

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-20230203165134

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: AEGIS LIVING GRANADA HILLS	FACILITY NUMBER: 197610151
	VISIT DATE: 07/21/2023

NARRATIVE

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towards them. Between 10:30am to 12:30pm, LPA obtained and reviewed copies of R1 and S1's records. A review of R1's records reveal that R1 can be aggressive and verbally disruptive. A review of S1's records do not indicate any history of disciplinary action for job performance during their employment with the facility.

Based on the information obtained, there was insufficient evidence to prove that S1 slapped R1. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

LIC9099 (FAS) - (06/04)

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