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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197690036
Report Date: 04/26/2023
Date Signed: 04/26/2023 12:31:43 PM

Substantiated


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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/24/2021 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20210824100000
FACILITY NAME:ELEVATIONSFACILITY NUMBER:
197690036
ADMINISTRATOR:JORDAN ARONOFFFACILITY TYPE:
772
ADDRESS:3836 KANAN ROADTELEPHONE:
(858) 695-4069
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY:6CENSUS: 6DATE:
04/26/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Christina Hemming - Operations SupervisorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff are violating clients personal rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA met with Christina Hemming and explaiend the reason for the visit.
On 08/25/2021, between 9:22 a.m. – 1:00 p.m., LPA conducted an unannounced complaint visit where LPA met with House Manager Taylor Pursel, interviewed clients, staff as well as reviewed and obtained copies of pertinent documents relevant to the investigation. On 04/20/2023, LPA conducted an unannounced subsequent complaint investigation and conducted physical plant at approximately 10:15am, interviewed staff, parties with knowledge of the situation between 1pm – 4pm. Additionally, at approximately 11am, LPA reviewed and obtained additional pertinent documents relevant to the investigation.

It was reported that staff are violating clients’ personal rights, as it was alleged that clients were asked to sign a document stating they would not contact licensing or other agencies to file any complaints, as well as not to slander the facility in the news.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
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 29-AS-20210824100000
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ELEVATIONS
FACILITY NUMBER: 197690036
VISIT DATE: 04/26/2023
NARRATIVE
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Continued from 9099

Interviews conducted and records reviewed revealed that a “Terms of Refund Waiver” was in fact provided to and signed by two (2) clients. The Refund waiver indicated that a “Refund would be applied to the client if they abided by the following terms: Client agrees to not slander Elevation Behavioral Health or its owner, Dr Priya Chaudhri, on the internet or any other form of media, Client agrees to not initiate in any lawsuit against Elevation Behavioral Health or its owner, Dr Priya Chaudri, Client agrees to not contact the state licensing board to make complaints of any sorts, about Elevation Behavioral Health or its owner, Dr Priya Chaudhri, Client agrees to not make complaints of any sorts to their insurance company, about Elevation Behavioral Health or its owner, Dr. Priya Chaudhri.” Based on information obtained over the course of the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that staff are violating clients’ personal rights has been deemed Substantiated at this time.

Pursuant to CCR, Title 22, Division 6, Chapter 8, the following deficiencies are cited (Refer to LIC 9099-D).

Exit interview conducted. Citation issued. Appeal Rights discussed and copy of the report was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20210824100000
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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ELEVATIONS
FACILITY NUMBER: 197690036
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/27/2023
Section Cited
CCR
81068(c)(5)
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81068(c)(5) Admission agreements must specify the following: Refund Conditions. This requirement was not met as evidenced by:
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Licensee agreed to submit a statement of understanding, detaining how the facility will maintain compliance of 81068(c)(5) and submit to LPA via email by COB 04/27/2023
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Based on LPA’s interviews and records review, the licensee did not comply with the section above by having 2 out of 2 clients sign a refund policy that was not approved by the department which indicated refunds would only issued to clients if they met certain terms, which is an immediate violation to clients personal rights.
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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: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/24/2021 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20210824100000

FACILITY NAME:ELEVATIONSFACILITY NUMBER:
197690036
ADMINISTRATOR:JORDAN ARONOFFFACILITY TYPE:
772
ADDRESS:3836 KANAN ROADTELEPHONE:
(858) 695-4069
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY:6CENSUS: 6DATE:
04/26/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Christina Hemming - Operations SupervisorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
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5
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9
Staff did not provide clients with a comfortable environment

Staff did not prevent clients from engaging in physical altercation resulting in injury
INVESTIGATION FINDINGS:
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3
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5
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7
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9
10
11
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13
Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA met with Christina Hemming and explained the reason for the visit.

On 08/25/2021, between 9:22 a.m. – 1:00 p.m., LPA conducted an unannounced complaint visit where LPA met with House Manager Taylor Pursel, interviewed clients, staff as well as reviewed and obtained copies of pertinent documents relevant to the investigation. On 04/20/2023, LPA conducted an unannounced subsequent complaint investigation and conducted physical plant at approximately 10:15am as well as interviewed staff, parties with knowledge of the situation between 1pm – 4pm. Additionally, at approximately 11am, LPA reviewed and obtained additional pertinent documents relevant to the investigation.

It was reported that staff did not provide clients with a comfortable environment, as it was alleged that Client 1 (C1) attacked Client 2 (C2), as well as disrupted the care of other clients in the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20210824100000
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ELEVATIONS
FACILITY NUMBER: 197690036
VISIT DATE: 04/26/2023
NARRATIVE
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Continued from 9099-A

Interviews conducted and records reviewed reflected that C1 and C2 were involved in a physical altercation during an approved unsupervised outing at a local mall on 07/17/2021, upon returning to the facility C2 informed staff who provided C2 with the appropriate first aid. Additionally, on 07/18/2021, C1 and Client 3 (C3), were involved in a verbal altercation at the facility. Information gathered reflected that during the 07/18/2021 incident staff intervened and re-directed both clients immediately. This incident led to increased supervision of C1 along with additional staffing to support other clients in care. C1 was relocated to Elevation Behavioral Health #197690045 on 07/20/2021 due to the increased concerns of other clients in care. Based on information gathered, the department does not have sufficient evidence to determine that staff failed to provide clients with a comfortable environment. Therefore, the above allegation is deemed Unsubstantiated at this time.

It was reported that staff did not prevent clients from engaging in physical altercation resulting in injury, as it was alleged that staff did not prevent Client 1 (C1) from engaging in a physical altercation with Client 2 (C2) during an outing. LPA records review of resident files and interviews with former clients and staff revealed, on 07/17/2021, C1, C2, and Client 3 (C3), went on an approved unsupervised outing to a local mall. During the outing a situation occurred where C2 attempted to get into an Uber, but C1 forcefully grabbed C2 on the arm to refrain C2 from getting into the vehicle. Upon return to the facility C2, informed staff and C2 was provided with ice and first aid, but refused other medical attention until 07/19/2021, where C2 requested to be admitted to urgent care. LPA’s interview with C2 revealed no injuries were observed during the urgent care visit, but C2’s arm was put into a sling for precautionary measures. Based on information obtained during this and previous visits, the department does not have sufficient evidence to determine this allegation occurred. Therefore, the allegation that staff did not prevent residents from engaging in physical altercations resulting in injury has been deemed Unsubstantiated at this time.

Exit interview conducted and copy of report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5