198601809-5-30-2025-29-AS-KLOZ-DMYRMR-20251031130908

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601809
Report Date: 05/30/2025
Date Signed: 05/30/2025 04:17:44 PM

Unsubstantiated

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
10/16/2024 and conducted by Evaluator Erica Mosley

COMPLAINT CONTROL NUMBER: 29-AS-20241016084833

FACILITY NAME:	ELWYN NC - BABCOCK		FACILITY NUMBER:	198601809
ADMINISTRATOR:	LAURIE HERNANDEZ		FACILITY TYPE:	734
ADDRESS:	5149 BABCOCK AVE		TELEPHONE:	(818) 287-5416
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	5	CENSUS: 2	DATE:	05/30/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Interim Administrator, Laurie Hernandez (telephonically) Jennifer Figueroa-Hernan, LVN, Nasteho Issa, RN		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

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Staff interfered with resident’s visits.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit to investigate the above listed allegation. The purpose of this visit is to deliver findings for the above listed allegation. Upon arrival at 10:00 a.m., LPA Mosley was greeted by staff who called the Administrator. The Administrator designated staff to sign the report and was available telephonically throughout the visit. The LPA met with interim Administrator, Laurie Hernandez telephonically, Jennifer Figueroa-Hernan, LVN and Nasteho Issa, RN and explained the reason for the visit.
On 10/15/2024 the Department received a complaint regarding the following allegation Staff interfered with resident’s visits. On 10/16/2024 LPA Mosley conducted the unannounced initial 10-day complaint visit. LPA conducted a physical plant tour to ensure there are no immediate health and safety concerns, from 1:50 p.m. – 4:30 p.m. LPA conducted in person interviews with the Administrator and one (1) staff, a telephonic interview with Responsible person of Resident #1 (RPR1), a file review, obtained copies of pertinent documents relevant to the investigation.
Report continued on LIC 9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

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 29-AS-20241016084833

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: 05/30/2025

NARRATIVE

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(Page 2) Report continued from LIC9099...
On 10/29/2024 LPA Mosley conducted an unannounced subsequent complaint joint visit with North Los Angeles County Regional Center (NLACRC), Quality Assurance Specialist (QAS) Lisseth Carrillo, Registered Nurse (RN) Consultant, Jennifer Castaneda and California Department of Developmental Services, DDS Nurse Consultant III, Dr. Arnold Franco, DNP, FNP-BC. LPA conducted a physical plant tour to ensure there are no immediate health and safety concerns, conducted in person interviews with two (2) staff from 12pm – 1pm. A file review and obtained copies of pertinent documents relevant to the investigation. From 11/18/2024 – 11/20/2024 LPA and North Los Angeles County Regional Center (NLACRC), Quality Assurance Specialist (QAS) Lisseth Carrillo corresponded via email and on 11/20/2024 at 3:00p.m. corresponded via video chat. On 05/06/2025 at 3:20 p.m. LPA conducted a telephonic interview with a family member / responsible person of a current client.

During today’s visit, starting at 10:08 a.m. LPA conducted the entrance interview and a brief physical plant tour to ensure there are no immediate health and safety concerns and facility is in compliance with Title 22 Regulations. At 11:57 a.m. conducted an in-person interview with a staff, at 12:12 p.m. conducted a telephonic interview with a former staff and collected copies of pertinent documents relevant to the investigation.

On the allegation Staff interfered with resident’s visits it is the concern of the reporting party (RP) that facility staff interfered with Resident #1 (R1) visits refusing R1 to go outside the facility for visits with RPR1. To investigate this complaint on 10/16/2024 from 1:50 p.m. – 4:30 p.m. LPA conducted in person interviews with the Administrator and one (1) staff, a telephonic interview with Responsible person of Resident #1 (R1), a file review, obtained copies of pertinent documents relevant to the investigation. On 10/29/2024 from 12 p.m. -1 p.m. LPA conducted in person interviews with two (2) staff, conducted a file review and obtained copies of pertinent documents relevant to the investigation. From 11/18/2024 – 11/20/2024 LPA and NLACRC, QAS Lisseth Carrillo corresponded via email and on 11/20/2024 at 3:00p.m. corresponded via video chat. On 05/06/2025 at 3:20 p.m. LPA conducted a telephonic interview with a family member / responsible person of a current client. On 05/30/2025 at 11:57 a.m. conducted an in-person interview with a staff at 12:12 p.m. conducted a telephonic interview with a former staff and collected copies of pertinent documents relevant to the investigation. Interviews with staff revealed that they have a doctor’s order on file that restricted R1 from going outside if the weather was below 65 degrees and above 90 degrees.

Report continued on LIC 9099-C Page 3....

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20241016084833

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: 05/30/2025

NARRATIVE

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(Page 3) Report continued from LIC9099-C Page 2...
Staff state that RPR1 had a difficult time when staff would state that R1 could not go outside due to the temperature and RPR1 would get upset and at time get verbally aggressive with staff. Staff state that they would tell RPR1 that they could stay indoors but because of the temperature they could not take R1 outside however PRR1 would get upset and leave the facility. Staff told RPR1 that they were following doctor’s orders. Interviews with RPR1 revealed that they visited R1 often and the facility started to put temperature restrictions on the visits. When the temperature is below 65 degrees and above 90 degrees, they were not able to go outside the facility and was something they did not agree with. RPR1 believed that the temperature restrictions were something the facility put into place to limit visitations. Correspondences via email and video chat with NLACRC QAS revealed that from visits and internal investigation they did not find any evidence to support the allegation. File review revealed that the facility had a doctor’s order dated 09/28/2021 stating due to cold or hot weather R1 should not spend more than 10 minutes at a time outside during the following temperature restrictions due to health and safety. When the temperature is below 65 degrees, and It Is raining/drizzling or when the temperature is over 90 degrees. Facility consumer notes revealed that there were multiple occasions 05/17/2023, 05/24/2023, 05/25/2023, 06/06/2023, 06/13/2023, 01/27/2024, and 08/01/2024 where the facility documented RPR1 not complying with the facility on following the doctors orders. Daily log notes revealed that RPR1 visited the facility frequently at times two (2) times a day and at times conducted video facetime calls. Interview with a family member / responsible person of a current client revealed that they visit the facility weekly on the weekends and have not had any issues with the facility or the facility staff. They have never had any issues with restrictions or visitations. They have never seen the staff refuse visitations or were refused visitation. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Staff interfered with resident’s visits is deemed unsubstantiated at this time.

No deficiencies were observed or cited during today’s inspection. Exit interview conducted. Report was reviewed and a copy and appeal rights were provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

LIC9099 (FAS) - (06/04)

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