197610258-9-1-2022-31-AS-EMIR-CJJT8F-20220923143013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610258
Report Date: 09/01/2022
Date Signed: 09/01/2022 02:46:27 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
08/25/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20220825175431

FACILITY NAME:	HOME FOR THE ELDERLY		FACILITY NUMBER:	197610258
ADMINISTRATOR:	GACAYAN, CAMERON		FACILITY TYPE:	740
ADDRESS:	19825 LEADWELL ST.		TELEPHONE:	(818) 718-2750
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91306
CAPACITY:	6	CENSUS: 4	DATE:	09/01/2022
		UNANNOUNCED	TIME BEGAN:	12:07 PM
MET WITH:	Francisco Fabrigas		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility is not allowing resident to have visits.
Facility not allowing resident access to a phone.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate allegations of personal rights. It was reported that Resident 1 (R1) is not allowed visitors, and staff are not putting calls through to R1. During the course of the investigation, interviews and record review were made.

Facility is not allowing Resident to have visits:
Regarding the allegation, according to the administrator, Francisco Fabrigas, R1 has been getting visits from his family every day. R1 has two family members that visits often. One family comes every day. The other one has come to the facility at least five times since R1 was admitted on 8/20/22. LPA obtained copies of the facility visitation log to confirm these visits from family were made. Furthermore, residents hasn't expressed any complaints or concerns about not having any visitors allowed. Based on the information obtained, there is insufficient evidence to corroborate the allegation of resident not being allowed visitors. Therefore the investigation is deemed Unsubstantiated at this time.

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: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

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-20220825175431

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: HOME FOR THE ELDERLY	FACILITY NUMBER: 197610258
	VISIT DATE: 09/01/2022

NARRATIVE

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Facility not allowing resident access to a phone.:
In regards to the allegation, it was reported that staff aren't putting calls through to residents. Interviews with the administrator, staff and residents deny the allegation. Residents had no complaints or concerns about not being able to make and receive telephone calls. According to the administrator, there was one incident, on or around 8/22/22, when the facility cordless phone wasn't fully charged, calls weren't coming through. The administrator explained this to resident family, and they understood and expressed no further concerns. The administrator has since replaced the facility phones with dual charged phones to prevent this incident from happening again. No other phone issues or concerns from resident family made. Based on the information obtained, there was insufficient evidence to prove that residents are not allowed access to the telephone. 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: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC9099 (FAS) - (06/04)

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