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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601809
Report Date: 08/15/2024
Date Signed: 08/16/2024 08:59:10 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
08/10/2024 and conducted by Evaluator Erica Mosley
COMPLAINT CONTROL NUMBER: 29-AS-20240810200537
FACILITY NAME:ELWYN NC - BABCOCKFACILITY NUMBER:
198601809
ADMINISTRATOR:HAZEL LAZAGA GATANFACILITY TYPE:
734
ADDRESS:5149 BABCOCK AVETELEPHONE:
(818) 287-5416
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:5CENSUS: 4DATE:
08/15/2024
UNANNOUNCEDTIME BEGAN:
10:43 AM
MET WITH:Laurie HernandezTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Staff used profanity in the presence of resident.
Staff engaged in verbal altercation in the presences of resident.
staff did not treat resident with dignity and respect.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Teresa Camara and Erica Mosley conducted a joint visit with North Los Angeles County Regional Center (NLACRC), Quality Assurance Specialist (QAS) Lisseth Carrillo on a complaint visit at the facility today. At 10:44 a.m., the LPAs and QAS met with staff and explained the reason for the visit. LPAs initially met with the staff LVN. The Administrator, Laurie Hernandez was not immediately available and arrived around 12:30 p.m.

During today’s visit, at 11:00 a.m. LPAs conducted a physical plant tour. Starting at 10:55 a.m LPAs conducted staff interviews. At 11:08 a.m. LPAs started reviewing and obtaining pertinent documents.

Continued on LIC 9099-C.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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-20240810200537
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: 08/15/2024
NARRATIVE
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(continued from LIC9099)

Regarding the allegations: Facility staff used profanity in the presence of residents, Staff engaged in a verbal altercation in the presences of residents, and staff did not treat residents with dignity and respect.

On 08/10/2024, the department received a complaint alleging staff used profanity in the presence of residents, staff engaged in verbal altercation with one another in the presences of residents, and staff did not treat residents with dignity and respect. A credible witness provided evidence of staff not providing a resident with dignity and respect by providing personal care in front of another resident.

During today’s staff interviews, it was revealed that two staff engaged in a verbal altercation in front of residents. Staff 1 (S1) does not work well with other staff which has made the facility feel unwelcome and antagonistic while S1 is working. In addition, a credible witness provided evidence of staff not providing privacy for a resident during personal care. Based on the interviews of staff and a credible witness, these allegations 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: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240810200537
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: 08/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2024
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights (a) Except for children’s residential facilities, 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 was not met as evidenced by:
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Licensee will provide staff with personal rights training and provide evidence of training on or before 8/30/2024.
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Based on interviews and evidence from a witness, the licensee did not comply with the section cited above as privacy was not provided to client and staff argued in front of client, which posed a potential health risk to persons in care.
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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: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
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