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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603595
Report Date: 05/16/2024
Date Signed: 05/16/2024 03:25:35 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
03/18/2024 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20240318122411
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: 2DATE:
05/16/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Giovanni AngelesTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff denied fluids to residents
Staff handled resident in a rough manner
Staff spoke inappropriately to residents
INVESTIGATION FINDINGS:
1
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4
5
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7
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9
10
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13
At 1:50 p.m. on 05/16/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent complaint visit. LPA met with staff and later the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 03/20/2024 interviewed the licensee at 11:30 a.m., the administrator at 2:30 p.m., and two (02) staff members at 2:40 p.m. and 2:50 p.m., conducted a record review of pertinent documents at 2:15 p.m. including but not limited to the staff roster, client face sheet, needs and service plan, preplacement appraisal, and admission agreement, and toured the facility at 2:25 p.m. LPA attempted to interview Client #3 (C3) at 2:55 p.m. on 03/20/2024 but was unsuccessful. LPA conducted additional staff interviews at 4:00 p.m. on 04/09/2024 with Staff #2 (S2), at 1:20 p.m. on 04/11/2024 with Staff #1 (S1), at 9:15 a.m. on 05/14/2024 with Staff #3 (S3), and at 10:30 a.m. on 05/14/2024 with Staff #4 (S4).

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
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 6
Control Number 31-AS-20240318122411
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PARKWOOD HOME LLC
FACILITY NUMBER: 198603595
VISIT DATE: 05/16/2024
NARRATIVE
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This page was amended to include additional information from further investigation. - LPA NR, 09/25/24

Regarding the allegation “Staff denied fluids to residents” it was alleged S1 denies clients water, juice, and soda. Interviews with the licensee and the administrator revealed no staff engage in denying food or water to clients. Interview with S1 revealed S1 never denied clients any liquids. Interview with S2 revealed S1 allowed Client #1 (C1) “a sip, but no more” of water. S2 further stated that C1 begs for water and can finish two (02) bottles when given to them. LPA was unable to communicate with and interview C3 or any other clients. Based on interviews, S1 denied a client water. Therefore, the allegation is deemed SUBSTANTIATED at this time. Deficiency is cited on the attached LIC 9099-D page. Regarding the allegation “Staff handled resident in a rough manner” it was alleged S1 engaged in abusive and restrictive physical actions against clients in the home. Interview with S1 revealed S1 denied ever physically abusing any clients. Interviews with the licensee and administrator revealed they had not received any reports of staff physically abusing residents to which there is a zero-tolerance policy. Interview with S2 revealed they witnessed S1 handling Client #2 (C2) in a rough manner. S1 shoved C2 and grabbed C2 by their neck and directed them to their room. LPA was unable to communicate with and interview C3 or any other clients. Based on interviews, S1 engaged in an abusive action towards C2. Therefore, the allegation is deemed SUBSTANTIATED at this time. Deficiency is cited on the attached LIC 9099-D page. Regarding the allegation “Staff spoke inappropriately to residents” it was alleged S1 engaged in verbally abusive actions against clients in the home. Interview with S1 revealed S1 denied ever verbally abusing any clients. Interviews with the licensee and administrator revealed they had not received any reports of staff verbally abusing residents. Interview with S2 revealed S1 has screamed at C3 and other clients on different occasions. Interview with S3 revealed S1 has raised their voice with clients. LPA was unable to communicate with and interview clients. Based on interviews, S1 engaged in verbally abusive actions towards clients. Therefore, the allegation is deemed SUBSTANTIATED at this time. Deficiency is cited on the attached LIC 9099-D page.

LPA and Licensing Program Manager (LPM) Naira Margaryan returned for additional investigation at 2:00 p.m. on 09/25/24. LPA and LPM interviewed the administrator, S3, and three (03) clients between 2:20 p.m. and 3:45 p.m., conducted a record review of client service plans at 2:45 p.m., and toured the home at 3:15 p.m.

No immediate health and safety risks were observed during today's visit. Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 31-AS-20240318122411
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: PARKWOOD HOME LLC
FACILITY NUMBER: 198603595
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2024
Section Cited
CCR
80072(a)(3)
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2
3
4
5
6
7
80072 Personal Rights (a) ... each client shall have personal rights which include... the following: (3) To be free from... actions of a punitive nature, including...: interference with the daily living functions, including... withholding... aids to physical functioning. This requirement is not met as evidenced by:
1
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Licensee has planned to terminate Staff #1 (S1) by the POC due date to ensure the safety of clients in care. Licensee will also provide in-service training to all staff and submit proof by POC due date.
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Based on interviews, the licensee did not comply with the section cited above in at least one (01) out of four (04) clients which poses a potential Health, Safety, or Personal Rights risk to clients in care.
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Type B
06/13/2024
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 requirement is not met as evidenced by:
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Licensee has planned to terminate Staff #1 (S1) by the POC due date to ensure the safety of clients in care. Licensee will also provide in-service training to all staff and submit proof by POC due date.
8
9
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Based on interviews, the licensee did not comply with the section cited above in at least one (01) out of four (04) clients which poses a potential Health, Safety, or Personal Rights risk to clients in care.
8
9
10
11
12
13
14
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: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 31-AS-20240318122411
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: PARKWOOD HOME LLC
FACILITY NUMBER: 198603595
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/13/2024
Section Cited
CCR
80072(a)(3)
1
2
3
4
5
6
7
80072 Personal Rights (a) ... each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion.
This requirement is not met as evdenced by:
1
2
3
4
5
6
7
Licensee has planned to terminate Staff #1 (S1) by the POC due date to ensure the safety of clients in care. Licensee will also provide in-service training to all staff and submit proof by POC due date.
8
9
10
11
12
13
14
Based on interviews, the licensee did not comply with the section cited above in at least one (01) out of four (04) clients which poses a immediate Health, Safety, or Personal Rights risk to clients in care.
8
9
10
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14
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1
2
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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: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
03/18/2024 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20240318122411

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: 2DATE:
05/16/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Giovanni AngelesTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff denied food to residents
Staff provided uncooked food to residents
Staff restricted residents from accessing their bedroom
Staff forced residents to remain in restrictive positions for extended periods of time
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 1:50 p.m. on 05/16/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent complaint visit. LPA met with staff and later the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 03/20/2024 interviewed the licensee at 11:30 a.m., the administrator at 2:30 p.m., and two (02) staff members at 2:40 p.m. and 2:50 p.m., conducted a record review of pertinent documents at 2:15 p.m. including but not limited to the staff roster, client face sheet, needs and service plan, preplacement appraisal, and admission agreement, and toured the facility at 2:25 p.m. LPA attempted to interview Client #3 (C3) at 2:55 p.m. on 03/20/2024 but was unsuccessful. LPA conducted additional staff interviews at 4:00 p.m. on 04/09/2024 with Staff #2 (S2), at 1:20 p.m. on 04/11/2024 with Staff #1 (S1), at 9:15 a.m. on 05/14/2024 with Staff #3 (S3), and at 10:30 a.m. on 05/14/2024 with Staff #4 (S4).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 31-AS-20240318122411
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PARKWOOD HOME LLC
FACILITY NUMBER: 198603595
VISIT DATE: 05/16/2024
NARRATIVE
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3
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5
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Regarding the allegation “Staff denied food to residents” it was alleged S1 denied food to clients in the home. Interview with S1 revealed S1 denied ever denying food to any clients. Interviews with the licensee and administrator revealed they had not received any reports of staff denying food to clients. Interviews with five (05) out of five (05) other staff between 03/20/2024 and 05/14/2024 revealed no staff had witnessed or were aware of any staff denying food to any clients. LPA was unable to communicate with and interview C3 or other clients. Based on interviews, no staff denied food to clients. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
Regarding the allegation “Staff provided uncooked food to residents” it was alleged S1 sometimes served uncooked oatmeal to clients in the home. Interview with S1 revealed S1 prepared oatmeal using milk and heated it in the microwave. S1 denied ever serving uncooked food. Interviews with the licensee and administrator revealed they had not received any reports of staff serving uncooked to clients. Interviews with five (05) out of five (05) other staff interviewed between 03/20/2024 and 05/14/2024 revealed no staff had witnessed or were aware of any staff serving uncooked food to clients. LPA was unable to communicate with and interview C3 or other clients. Based on interviews, no staff served uncooked food to clients. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
Regarding the allegation “Staff restricted residents from accessing their bedroom” it was alleged S1 denied all clients from going to their bedroom before a certain time. Interview with S1 revealed S1 denied ever restricting client movement or freedom to go to their bedrooms. Interviews with the licensee and administrator revealed they had not received any reports of staff restricting client movement or bedroom access. Interviews with five (05) out of five (05) other staff between 03/20/2024 and 05/14/2024 revealed staff had not witnessed or were aware of any staff denying bedroom access to clients. LPA was unable to communicate with and interview C3 or other clients. Based on interviews, no staff restricted clients from accessing their bedrooms. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
Regarding the allegation “Staff forced residents to remain in restrictive positions for extended periods of time” it was alleged S1 forced clients to sit on their fingers when they engaged in a stimming behavior. Interview with S1 revealed S1 denied ever forcing clients to sit on their hands. S1 ensures clients are safe when they engage in behaviors. Interviews with the licensee and administrator revealed they had not received any reports of staff restricting client movement or forcing clients to sit on their hands. Interviews with five (05) out of five (05) other staff between 03/20/2024 and 05/14/2024 revealed staff had not witnessed or were aware of any staff forcing clients into restrictive positions. LPA was unable to communicate with and interview C3 or other clients. LPA observed clients moving freely in the house on 03/20/2024 and 05/16/2024. Based on interviews, no staff forced clients into restrictive positions. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
No immediate health and safety risks were observed. Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6