198603136-6-7-2021-28-AS-MVAO-C5APZ7-20210726114505

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 06/07/2021
Date Signed: 06/07/2021 03:21:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/17/2020 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201117170750

FACILITY NAME:	LE BLEU CHATEAU		FACILITY NUMBER:	198603136
ADMINISTRATOR:	SOKOLOWSKI, MICHAEL		FACILITY TYPE:	740
ADDRESS:	1900 GRISMER AVE		TELEPHONE:	(818) 843-3141
CITY:	BURBANK	STATE: CA	ZIP CODE:	91504
CAPACITY:	100	CENSUS: 65	DATE:	06/07/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	William "Bill" Boles and Marili Barajas		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff financially abused resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegation. LPA met with William "Bill" Boles (Facility Administrator) and Marili Barajas (Office Manager) and discussed the pupose of today's visit.

On 11/19/2020, LPA initiated this investigation. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, LPA conducted this investigation telephonically with Michael Sokolowski (Facility Administrator). Note: As of today's visit, Mr. Sokolowski is no longer working at this facility. LPA obtained relevant documentation for this complaint investigation.

During today's visit, LPA interviewed the Facility Office Manager, Staff #1 (S-1) and Resident #1 through Resident #4 (R-1 through R-4). LPA was unable to interview Resident #5 (R-5) as R-5 was sleeping at the time of this visit.

***Refer to LIC 9099C for the continuation of this report***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

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-20201117170750

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LE BLEU CHATEAU	FACILITY NUMBER: 198603136
	VISIT DATE: 06/07/2021

NARRATIVE

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Allegation: Staff financially abused resident. During this investigation, LPA interviewed the Office Manager, S-1 and R-1 through R-4. R-5 was unable to be interviewed and R-5 was asleep during today's visit. Staff interviews revealed that the Facility Office Manager handles Residents' monies and keeps a current log of expenditures. Per Facility Office Manager, there are (5) Residents' that receive assistance with money handling. Per Office Manager, the Office Manager is the only person responsible in handling the Residents' monies. Per Office Manager, there has not been any complaints/concerns from anyone in regards to staff financially abusing Residents. Per Office Manager, staff are trained on Mandated Reporting and Resident Rights. (4) out of (5) interviewed Residents indicated that the Office Manager handles their monies, staff do not financially abuse Residents and that they (Residents) have not witnessed any staff taking any money from Residents. (1) out (5) Resident was not interviewed as that Resident was asleep during today's visit. Staff and Resident interviews do not corroborate this allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted. A copy of this report and Appeal Rights were provided to Mr. Boles.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

LIC9099 (FAS) - (06/04)

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