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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610235
Report Date: 11/21/2024
Date Signed: 11/21/2024 02:06:16 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
06/21/2023 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230621122912
FACILITY NAME:WYSE HOMEFACILITY NUMBER:
197610235
ADMINISTRATOR:LABEODAN, TAYOFACILITY TYPE:
737
ADDRESS:35158 WYSE ROADTELEPHONE:
(626) 500-1430
CITY:SANTA CLARITASTATE: CAZIP CODE:
91390
CAPACITY:4CENSUS: 1DATE:
11/21/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:LaQuencia DavisTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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1. Facility did not have sufficient staff to meet the needs of the clients
2. Staff are not adequately trained and certified
3. Facility staff did not follow clients Individualized Program Plan
4. Facility staff did not comply with the terms of the clients admission agreement
5. Facility staff are not qualified
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator LaQuencia Davis and informed her the reason of the visit, which was to deliver the final findings of the allegations mentioned above:

Allegation #1: It was alleged that the facility did not have sufficient staff to meet the needs of the clients. To investigate the allegation, on 06/21/2023, between 8:30 AM and 2:30 PM, (LPA) reviewed the Corrective Action Plan (CAP) issued by the North Los Angeles Regional Center (NLARC) to the facility. The CAP addressed numerous deficiencies cited during a semi-annual audit conducted on 05/17/2023 to 06/14/2023. As part of the audit, the payroll records for 04/03/2023 through 04/16/2023 were reviewed, revealing a deficit in staffing hours. The facility requires (5) staff members per shift to meet clients needs; however, the documentation showed that staffing levels fell below this requirement during the specified period. The facility Administrator acknowledged the insufficient staffing and did not dispute the findings. This poses as a health and safety risk to clients in care. Therefore, based on documentation and interviews, the allegation is Substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
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 5
Control Number 31-AS-20230621122912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WYSE HOME
FACILITY NUMBER: 197610235
VISIT DATE: 11/21/2024
NARRATIVE
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Allegation #2: It was alleged that staff are not adequately trained and certified. To investigate the allegation, on 06/21/2023, between 8:30 AM and 2:30 PM, (LPA) reviewed the Corrective Action Plan (CAP) issued by the North Los Angeles Regional Center (NLARC) to the facility. The CAP addressed numerous deficiencies identified during a semi-annual review conducted fom 05/17/2023 to 06/14/2023. As part of the audit, personnel records were reviewed, revealing that staff did not complete or maintain the required training and certifications, including Registered Behavior Technician (RBT) certification and First Aid/CPR training, during specific time frames. Additionally, staff did not complete the required minimum of (20) hours of CEU's continuing education units within the 1st year of employment. This poses a potential health and safety risk to clients in care. Therefore, based on documentation reviewed, the allegation is deemed Substantiated.

Allegation #3: It was alleged that facility staff did not follow the consumer's Individualized Program Plan (IPP). To investigate the allegation, on 06/21/2023, between 8:30 AM and 2:30 PM, (LPA) reviewed the Corrective Action Plan (CAP) issued by the North Los Angeles Regional Center (NLARC) to the facility. The CAP was created following a semi-annual review conducted from 05/17/2023 to 06/14/2023, which identified several deficiencies. The (CAP) revealed documentation that the facility was not following the client's Individualized Program Plan (IPP) as required due to lack of staffing and training required. The non-compliance with the client's IPP could of caused the client's developmental progress and well-being. This poses a potential health and safety risk to clients in care. Therefore, based on documentation reviewed, the allegation is deemed Substantiated.

Allegation # 4: It was alleged that facility staff did not comply with the terms of the clients admission agreement. On 06/21/2023, (LPA) reviewed the Corrective Action Plan (CAP) issued by the North Los Angeles Regional Center (NLARC) to the facility. The CAP addressed deficiencies identified during a semi-annual review conducted by NLARC from 05/17/2023 to 06/14/2023. To investigate the allegation, the (CAP) issued by Regional Center, identified the DS6023 (Rate Development – Facility Costs) and DS6024 (Rate Development – Individual Costs Associated with Residency) not in compliance with services that are supposed to be rendered to clients. The review revealed that the facility was not in compliance with these documents, as it failed to provide adequate staffing and ensure required staff training. These deficiencies violate the basic services outlined in the clients admission agreements, which are required to reflect the actual services rendered to clients in care. This poses as potential health and safety risk to clients. Therefore, based on documentation reviewed, the allegation is Substantiated.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 31-AS-20230621122912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WYSE HOME
FACILITY NUMBER: 197610235
VISIT DATE: 11/21/2024
NARRATIVE
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Allegation #5: It was alleged that facility staff are not qualified. To investigate the allegation, on 06/21/2023, between 8:30 AM and 2:30 PM, (LPA) reviewed the Corrective Action Plan (CAP) issued by the North Los Angeles Regional Center (NLARC) to the facility. The CAP addressed deficiencies identified during a semi-annual review conducted by NLARC from 05/17/2023 to 06/14/2023. The (CAP) issued identified personnel records, including certifications, training logs, and job descriptions as not in compliance. The review revealed that multiple facility staff lacked required qualifications for their positions. Specifically, staff were found to be missing certifications such as First Aid/CPR and specialized training relevant to the care of clients with specific needs. Additionally, some staff failed to meet minimum education or experience requirements as outlined in the facility's staffing plan and regulatory standards. This poses a potential health and safety risk to clients in care. Therefore, based on documentation reviewed, the allegation that facility staff are not qualified is deemed Substantiated.

Citations issued, appeal rights, and copy of report provided.

Note, all deficiencies and citations issued were cleared with proper documentation of training and staff certificates needed for the (CAP) received by Regional Center. Therefore, POC's are cleared and no further requirement is needed at this time.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20230621122912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WYSE HOME
FACILITY NUMBER: 197610235
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/21/2024
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision: (a)The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met, evidenced by, the Corrective Action Plan (CAP) issued by Regional Center during a semi-annual audit, determined the facility
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Administrator has AGREED to provide required documents that was requested by Regional Center, in the CAP, pertaining adhering to all regulations for Title 17 & 22 Regulations. Documentation received..POC cleared.
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revealed a deficit in staffing hours. The facility requires (5) staff members per shift. This poses as a potential health and safety risk to clients in care.
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Type B
11/21/2024
Section Cited
CCR
85078(a)(1)
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Responsibility for Providing Care and Supervision: (a)In addition to Section 80078, the following shall apply: (1)The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs.

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Administrator has AGREED to provide required documents that was requested by Regional Center, in the CAP, pertaining adhering to all regulations for Title 17 & 22 Regulations. Documentation received..POC cleared.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20230621122912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WYSE HOME
FACILITY NUMBER: 197610235
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/21/2024
Section Cited
CCR
89965(b)(2)
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Personnel Requirements: (b)The licensee shall ensure that each direct care staff person meets the following qualifications:(2) Become a Registered Behavior Technician within twelve (12) months of initial employment. This requirement was not met, evidenced by, during the semi-

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Administrator has AGREED to provide required documents that was requested by Regional Center, in the CAP, pertaining staff training which includes RBT certifications...Documentation received..POC cleared.
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annual audit by Regional Center, staff did not complete or maintain the required training and certifications. This poses as a potential health and safety risk to clients in care.
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Type B
11/21/2024
Section Cited
CCR
89965(k)(1)
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Personnel Requirements: (k)In addition to any other required training, prior to providing direct client care, the licensee shall ensure that each direct care staff person receive hands-on training in first aid and cardiopulmonary resuscitation. (1) Direct care stall shall maintain current certifications
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Administrator has AGREED to provide required documents that was requested by Regional Center, in the CAP, pertaining staff training which includes First/Aide and other required training needed. Documentation received..POC cleared.
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in first aid and cardiopulmonary resuscitation...This requirement was not met, evidenced by, during the semi-annual audit by Regional Center,staff did not complete or maintain the required training. This poses as a potential health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5