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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603595
Report Date: 04/17/2024
Date Signed: 04/17/2024 03:32:36 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/12/2024 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20240412152511
FACILITY NAME:PARKWOOD HOME LLCFACILITY NUMBER:
198603595
ADMINISTRATOR:VALDEZ, ABRAHAMFACILITY TYPE:
735
ADDRESS:301 PARKWOOD LNTELEPHONE:
(818) 240-4568
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY:5CENSUS: 4DATE:
04/17/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Juan Guzman, DSP IITIME COMPLETED:
03:32 PM
ALLEGATION(S):
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Resident sustained suspicious injury while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegation. LPA met with DSP II Juan Guzman and explained the reason for the visit.

It was reported that a resident sustained a suspicious injury while in care. It was alleged that Resident #1 (R1)'s left ear was partially detached from the top. To investigate this allegation on 4/17/2024 between 12:00pm and 12:45pm, staff interviews were initiated. Interviews revealed that R1's left ear was not partially detached, but rather an ulcer like blister developed from using a surgical face mask. R1 was pulling on the face mask constantly and due to skin sensitivity developed an ulcer. Between 1:00pm and 1:30pm, facility files were reviewed. Records confirmed what staff told LPA.

Based on interviews and records review, there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.
Continue on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
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 2
Control Number 31-AS-20240412152511
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PARKWOOD HOME LLC
FACILITY NUMBER: 198603595
VISIT DATE: 04/17/2024
NARRATIVE
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No health and safety issues noted at the time of this visit.

Exit interview conducted and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2