198601809-3-17-2025-29-AS-KLOZ-DG93RS-20250430182914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601809
Report Date: 03/14/2025
Date Signed: 03/17/2025 08:43:50 AM

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
05/29/2024 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20240529113149

FACILITY NAME:	ELWYN NC - BABCOCK		FACILITY NUMBER:	198601809
ADMINISTRATOR:	HAZEL LAZAGA GATAN		FACILITY TYPE:	734
ADDRESS:	5149 BABCOCK AVE		TELEPHONE:	(818) 287-5416
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	5	CENSUS: 2	DATE:	03/14/2025
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Nancy Reyes		TIME COMPLETED:	03:23 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff conduct poses a risk to residents in care.
Staff do not ensure that resident follows a special diet.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent visit to deliver findings for the allegations listed above. The LPA met with Nancy Reyes, RN House Manager, and explained the reason for the visit. The Administrator Laurie Hernandez was not available at the time of the visit.

On 06/06/2024, Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegations listed above. The LPA conducted a joint visit with Supervisor Xochitl Aragon from North Los Angeles County Regional Center, and Dr. Arnold Franco from the Department of Developmental Services. The LPA met with staff Eivet Azizian and explained the reason for the visit. The staff contacted the administrator, Vernon Rodriguez. Administrator arrived after LPA Urena left the facility.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025

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-20240529113149

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: 03/14/2025

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

This page was amended to remove the citation.
Staff conduct poses a risk to residents in care.
On the allegation that staff conduct poses a risk to residents in care, it is the concern of the reporting party (RP) that two staff conducted themselves in an unprofessional manner by having a verbal altercation in the presence of residents, thus creating a stressful environment for residents in care. To investigate the allegation, LPA Urena interviewed facility staff, the Administrator and agency staff. Interviews revealed that two staff engaged in a verbal altercation in front of residents. Staff 1 (S1) does not work well with other staff (S2). LPA Urena was unable to interview both staff (S1, S2), as both were out on leave. The CCL department received an Incident Report (LIC 624) from the facility informing the department about the altercation between two facility staff.

Based on the information obtained through interviews, and record review, the allegation is deemed Substantiated at this time. (A duplicate if this allegation was filed on 08/10/2024 and Substantiated. POC was submitted on 08/15/2024).

Staff do not ensure that resident follows a special diet.
On the allegation that staff do not ensure that the resident follows a special diet, it is the concern of the RP that the staff were giving coffee and too much water to the resident (R1). To investigate the allegation, LPA Urena interviewed the staff, and reviewed menus for the facility and care plan for R1. The staff stated that R1 does eat hamburgers and fries, but only occasionally. On the allegation of that R1 was receiving too much water, the staff stated that R1 receives fluids as needed, however, R1 was admitted to the hospital on 07/08/2024 due to fluid overload per the Incident Report submitted to the Regional Office, and review of hospital records.

Based on the information obtained through interviews, and record review, the allegation is deemed Substantiated at this time. A duplicate of this allegation was filed on 08/10/2024 under complaint control 29-AS-20240810200537. The allegation was substantiated on 08/15/2024, therefore, a citation is not being issued under this report for the allegation at this time.
Exit interview was conducted and a copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 29-AS-20240529113149

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: 03/14/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/14/2025 Section Cited CCR 80072	1 2 3 4 5 6 7	80072 Personal Rights (a) Except for children’s ... each client shall have personal rights which include, but are not limited to, the following: (1)To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee provided staff with personal rights training and provided evidence of training on 8/15/2024.
	8 9 10 11 12 13 14	Based on interviews and evidence from a witness, the licensee did not comply with the section cited above as privacy was not provided to resident and staff argued in front of client, which posed a potential health risk to persons in care.	8 9 10 11 12 13 14
Type B 03/28/2025 Section Cited CCR 80072(a)2	1 2 3 4 5 6 7	80072 (a) 2 Personal Rights..., each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe, healthful … to meet his/her needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Administrator will ensure staff receives training on Policy #600-Nutrition and Hydration Policy Procedure by POC due date, and will email proof to LPA.
	8 9 10 11 12 13 14	Based on record review, the licensee did not comply with the section cited above when S2 failed to adhere to the physician’s order and provided R1 with more than what was prescribed, which poses a potential health and safety risk to persons in care.	8 9 10 11 12 13 14

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: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
05/29/2024 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20240529113149

FACILITY NAME:	ELWYN NC - BABCOCK		FACILITY NUMBER:	198601809
ADMINISTRATOR:	HAZEL LAZAGA GATAN		FACILITY TYPE:	734
ADDRESS:	5149 BABCOCK AVE		TELEPHONE:	(818) 287-5416
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	5	CENSUS: 2	DATE:	03/14/2025
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Nancy Reyes		TIME COMPLETED:	03:23 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not maintain a comfortable temperature for residents in care.
Staff do not provide resident oxygen as prescribed.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 29-AS-20240529113149

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: 03/14/2025

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

Staff do not maintain a comfortable temperature for residents in care.
On the allegation that staff do not maintain a comfortable temperature for residents in care, it is the concern of the RP that staff (S2) had a resident (R1) sitting outside in the patio when the temperature was at 63 degrees and the resident had been coughing. To investigate the allegation the LPA interviewed facility staff and agency staff. The interviews revealed that they had not witnessed the occurrence when S2 had a resident sitting outside. Furthermore, the interviews revealed that the one-to-one caregiver for R1 stated that they ensure they keep R1 within a comfortable temperature.
Although the allegation may have happened or is valid, based on the interviews, observation, there is not sufficient evidence to prove the alleged violation did or did not occur; therefore, the allegation is deemed Unsubstantiated at this time.

Staff do not provide resident oxygen as prescribed.
On the allegation that staff are not following oxygen prescription orders, it is the concern of the RP that the staff is giving one of the resident’s oxygen every day, and that’s why the resident is having a hard time breathing on their own. To investigate the allegation the LPA interviewed staff and review resident records. Staff (S3) stated that they follow the physicians’ orders. The one-to-one caregiver for R1 (from an outside agency) stated that they have never seen staff provide oxygen to R1. The LPA was unable to interview the RP to gather additional information about the resident receiving oxygen every day, as no contact information was provided.

Although the allegation may have happened or is valid, based on the interviews, observation, there is not sufficient evidence to prove the alleged violation did or did not occur; therefore, the allegation is Unsubstantiated at this time.

No citations were issued. Exit interview was conducted. A copy of the repot was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 5