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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601809
Report Date: 10/16/2024
Date Signed: 10/16/2024 04:23:41 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
10/10/2024 and conducted by Evaluator Erica Mosley
COMPLAINT CONTROL NUMBER: 29-AS-20241010160027
FACILITY NAME:ELWYN NC - BABCOCKFACILITY NUMBER:
198601809
ADMINISTRATOR:LAURIE HERNANDEZFACILITY TYPE:
734
ADDRESS:5149 BABCOCK AVETELEPHONE:
(818) 287-5416
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:5CENSUS: 3DATE:
10/16/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Laurie Hernandez- Administrator
Paul Ramos - Director of Quality Improvement 		TIME COMPLETED:
04:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is operating out of ratio.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced initial 10-day complaint visit to investigate the above allegation. Upon arrival at approximately 9:30 am, LPA Mosley were greeted by staff and called the administrator to inform them of the visit. The Administrator Laurie Hernandez arrived later during the visit. The LPA met with Eivet Azizian, LVN, Paul Ramos - Director of Quality Improvement and Administrator Laurie Hernandez and explained the reason for the visit.

On 10/10/2024, the Department received a complaint regarding the following allegation, Facility is operating out of ratio. LPA toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards and facility is in compliance with Title 22 Regulations.

Report Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
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 3
Control Number 29-AS-20241010160027
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: ELWYN NC - BABCOCK
FACILITY NUMBER: 198601809
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/16/2024
Section Cited
CCR
85065.5
1
2
3
4
5
6
7
85065.5 Day Staff-Client Ratio
(a)…the following minimum staffing requirements shall be met: (1) For Regional Center clients, staffing shall be maintained as specified by the Regional Center…This requirement was not met as evidenced by: Based on interviews ...
1
2
3
4
5
6
7
The Administrator has addressed the insufficient staffing ratios. Administrator has implemented adding another staff to the schedule and will submit the staffing schedule to CCL 10/16/2024.
8
9
10
11
12
13
14
 the licensee did not comply with the section cited above as C2 requires 1:1 support and was left alone by staff, which posed an immediate health and safety risk to clients in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20241010160027
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ELWYN NC - BABCOCK
FACILITY NUMBER: 198601809
VISIT DATE: 10/16/2024
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
On the allegation, facility is operating out of ratio, it is the concern of the Reporting Party (RP) that facility was operating out of ratio as Client # 2 (C2) who requires one (1) to one (1) supervision was observed to not be receiving one (1) to one (1) supervision on 09/24/2024. To investigate this complaint, LPA conducted in person interviews with the Administrator, Two (2) Staff between 9:45 am – 11:00 am. LPA also obtained pertinent documents to the investigation and reviewed facility records.

Interviews with two (2) staff revealed that both Staff 1 (S1) and Staff 2 (S2) were scheduled and present on 09/24/2024. Staff noted that they originally had three (3) staff scheduled but Staff 3 (S3) had called out due to a family emergency leaving the facility out of ratio. Staff stated they typically have three (3) staff scheduled. One (1) Lead staff /Nurse on the floor, one (1) staff as a one (1) to one (1), and one (1) Direct Support Professional. Lead staff and Administrator attempted to find coverage, however unsuccessful. The staff remained as one (1) Lead staff / Nurse on the floor, one (1) staff as a one (1) to one (1). S1 required assistance moving Client 1 (C1) from bed to chair. S2 assisted S1 in moving the client. At this time, the facility was out of ration leaving Client 2 (C2), who requires a one (1) to one (1) alone to assist S1. Staff stated that policy requires two (2) staff to transfer clients from bed to chair or from chair to bed. Interview with Administrator and file review support that the facility was out of ratio on 09/24/2024.

Based on information obtained, interviews with staff and a credible witness, the allegation, facility is operating out of ratio are deemed Substantiated at this time.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8 and California Health and Safety Code the following deficiencies were observed and cited during the visit (See 9099-D).

Exit interview conducted. A copy of the report and appeal rights were provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3