<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320108
Report Date: 10/13/2023
Date Signed: 10/13/2023 01:21:36 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/12/2023 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 11-AS-20231012124542
FACILITY NAME:ATARAXIS HOMES #1FACILITY NUMBER:
198320108
ADMINISTRATOR:BUCKMAN, JAMESFACILITY TYPE:
740
ADDRESS:6732 WOOSTER AVETELEPHONE:
(323) 573-4554
CITY:LOS ANGELESSTATE: CAZIP CODE:
90056
CAPACITY:6CENSUS: 6DATE:
10/13/2023
UNANNOUNCEDTIME BEGAN:
08:01 AM
MET WITH:Lori BuckmanTIME COMPLETED:
01:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not ensure that staff has a criminal clearance.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/13/2023, Licensing Program Analyst (LPA), Antonine Richard conducted an unannounced complaint visit to initiate the investigation on the above-mentioned complaint allegation. LPA met with Administrator Assistant Brianne Bunch and the purpose of the visit was explained.

The investigation consisted of the following: During todays visit, LPA Richard conducted a tour of the facility, inside to observe any signs of neglect, or abuse. interviewed the assistant Administrator S3, Administrator Staff S2, Staff S3,and S5. LPA interviewed the Licensee S1, and residents (R1-R3). LPA reviewed Staff and residents records.

Evaluation Report Continues LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
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 2
Control Number 11-AS-20231012124542
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ATARAXIS HOMES #1
FACILITY NUMBER: 198320108
VISIT DATE: 10/13/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Licensee does not ensure that staff has a criminal clearance.

The details of the complaint reported that licensee does not ensure that staff has a criminal clearance. The complainant stated there are undocumented staff working at the facility. LPA reviewed/audited personnel staff (S1-S5) and it revealed that (S1-S5) does have Criminal Background Clearance on file. The Licensee stated the individuals stated in the complaint came one month ago for an interview was told and given the hire package to complete before they could be hire. Since then she has not spoken to them about employment status. S5 has been employed at this facility since 10/03/23, and is included in (CCL) Facility Personnel Report Summary (LIS) as cleared. Based on the information gathered, Records reviewed, interviews, the allegation listed above is not supported.


Based on record reviews, observation and interviews conducted, the Department did not find sufficient evidence to support the allegation. Licensee does not ensure that staff has a criminal clearance.

Although the allegation (s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the above allegation is found to be Unsubstantiated.


Exit interview was conducted and a copy of the report was provided to Licensee Lori Buckman.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2