197610399-5-21-2025-31-AS-NGID-DJ7TV2-20250702150312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610399
Report Date: 05/21/2025
Date Signed: 05/21/2025 03:44:05 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
05/13/2025 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20250513085548

FACILITY NAME:	EMPOWER RESIDENTIAL WELLNESS CENTER LLC		FACILITY NUMBER:	197610399
ADMINISTRATOR:	DAHLMANN, MARIA		FACILITY TYPE:	772
ADDRESS:	22119 BASSETT STREET		TELEPHONE:	(818) 209-5011
CITY:	CONOGA PARK	STATE: CA	ZIP CODE:	91303
CAPACITY:	6	CENSUS: 5	DATE:	05/21/2025
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Michele Clark, Program Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff made inappropriate comments about a client while in care
Staff did not safeguard a client's personal belongings
Staff are mistreating a client while in care

INVESTIGATION FINDINGS:

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At 9:10am, Licensing Program Analyst (LPA), Angela Panushkina conducted an unannounced visit in response to the above-mentioned allegations. LPA met with the Program Director and explained the reason for the visit.

At 9:20am, LPA requested client and staff roster. At 9:30am requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s report, Appraisal Needs and Services Plan, Individual Therapy Notes, Client Observation Policy, Theft and Loss Policy, House Rules, Staff Training, relevant to the investigation. At approximately 9:50am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 10:00am – 1:00pm, LPA conducted an interview with the Program Director, Operations Manager, and a Licensed Vocational Nurse (LVN) and five (5) out of five (5) clients.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

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-20250513085548

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: EMPOWER RESIDENTIAL WELLNESS CENTER LLC	FACILITY NUMBER: 197610399
	VISIT DATE: 05/21/2025

NARRATIVE

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Allegation: Staff made inappropriate comments about a client while in care

To investigate this allegation, LPA conducted an interview with the Program Director, Operations Manager, and a Licensed Vocational Nurse (LVN). All parties interviewed denied the above allegation and informed LPA that the staff always takes care of all clients with dignity and respect. LPA was also informed that facility conducts monthly meetings with all staff regarding the basic services, personal rights, mandated reporter, etc. LPA conducted review of all training documents and confirmed the completion of training. Furthermore, LPA conducted interviews with five (5) clients and four (4) out of five (5) clients interviewed expressed no concern regarding this allegation. Based on interviews and an information obtained, there is not enough sufficient evidence to support the allegation. Therefore, the allegation is Unsubstantiated, at this time.

Allegation: Staff did not safeguard a client's personal belongings

To investigate this allegation, LPA conducted an interview with the Program Director and was informed that upon admission all clients personal belongings must be inventoried. In addition, pictures of all personal items must be taken and attached to client’s individual file. Interview with the Operations Manager and Licensed Vocational Nurse (LVN) confirmed the statement provided by the Program Director. Both parties interviewed also informed LPA that during the employee orientation training, employees are made aware of the facility theft and loss policy and their role in safeguarding the clients’ belongings. Five (5) out of five (5) clients interviewed expressed no concern regarding this allegation. Clients interviewed stated; while living at the facility, they have not had any personal items stolen and feel confident that staff adequately safeguard their personal items. Lastly, LPA conducted review of Client/Resident Personal Property and Valuables and observed a proper inventory log with signatures. Based on interviews and an information obtained, there is not enough sufficient evidence to support the above allegation. Therefore, the allegation is Unsubstantiated, at this time.

Continue on LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250513085548

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: EMPOWER RESIDENTIAL WELLNESS CENTER LLC	FACILITY NUMBER: 197610399
	VISIT DATE: 05/21/2025

NARRATIVE

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Allegation: Staff are mistreating a client while in care

It was alleged that C2 used a foul/inappropriate language towards C1, and the staff didn’t do anything about it. To investigate this allegation, LPA conducted an interview with the Program Director, Operations Manager and Licensed Vocational Nurse (LVN). All parties interviewed denied the above allegation and informed LPA that once they witness an inappropriate client-to-client communication, they immediately intervene and investigate the situation. Moreover, the staff redirect and remind all clients about the house rules and that they are not allowed to speak to each other in that manner. Program Director and LVN also informed LPA that they have an open-door policy and that all clients always have an option to speak with them, if needed. Four (4) out of five (5) clients interviewed, expressed no concern regarding this allegation. Clients also informed LPA that their Personal Rights have been respected by the facility staff. Lastly, during today's visit, LPA observed all five (5) clients showed respect towards each other. LPA also observed a friendly environment among the clients and the facility staff. Based on interviews and LPA observation there is not enough information to verify the allegation did or did not happen. Therefore, the allegation is Unsubstantiated, at this time.

No deficiency issued during today's visit.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

LIC9099 (FAS) - (06/04)

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