198602949-10-3-2023-28-AS-NMAN-CWB24Q-20231004170418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602949
Report Date: 03/13/2023
Date Signed: 10/03/2023 12:07:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/27/2022 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 28-AS-20221227165308

FACILITY NAME:	VALLEY BOARD AND CARE		FACILITY NUMBER:	198602949
ADMINISTRATOR:	RECTO CECILE		FACILITY TYPE:	735
ADDRESS:	2220 N LAMER STREET		TELEPHONE:	(818) 263-4222
CITY:	BURBANK	STATE: CA	ZIP CODE:	91504
CAPACITY:	6	CENSUS: 2	DATE:	03/13/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Cecilia Recto		TIME COMPLETED:	12:27 PM

ALLEGATION(S):

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Licensee coerced resident to sign admission agreement.
Licensee is not honoring the terms and condition of admission agreement.

INVESTIGATION FINDINGS:

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***This report is amended to add additional information***
Licensing Program Analyst (LPA) Tihesha Smith made an unannounced complaint visit to this facility at 10:00 am to deliver findings. LPA Smith met with facility staff and disclosed the purpose of this visit. The administrator was contacted and arrived later.
During initial visit, on 01/03/23, LPA Smith conducted tour of physical plant, conducted interviews with administrators and requested documents relevant to the investigation from approximately 11:05 am -1230 pm.
Licensee coerced resident to sign admission agreement
It was alleged that Licensee coerced resident to sign admission agreement. During initial visit LPA Smith conducted interview with administrator and reviewed relevant facility records LPA was unable to interview Resident #1 (R1) as R1 no longer resides at facility. Interview with administrator revealed that R1 was an emergency placement and did not make or coerce R1 to sign admissions agreement. Administrator revealed R1 refused to sign admissions agreement and only signed personal property
(Cont. from 9099)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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 28-AS-20221227165308

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: VALLEY BOARD AND CARE	FACILITY NUMBER: 198602949
	VISIT DATE: 03/13/2023

NARRATIVE

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( Cont from 9099)

record during move in and on move out. Interview with one (1) out of two (2) resident reveal was not coerced by Licensee to sign admission agreement.

Based on interviews and documents obtained during this and previous licensing visits there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time

Licensee is not honoring the terms and condition of admission agreement.

It was alleged that the licensee is not honoring the terms and condition of the admissions agreement. Interview with administrator revealed no admissions agreement was signed by R1 as R1 refused to sign the admissions agreement. The administrator revealed even though R1 refused to sign admissions agreement she still provided private room/board, and meals for R1 due to R1 being an emergency placement. Interview with one (1) out of two (2) residents reveal that licensee is honoring terms and condition of admission agreement and staff always provide assistance when requested.

Based on interviews during this and previous licensing visits there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted/Copy of report given.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC9099 (FAS) - (06/04)

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