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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603595
Report Date: 09/25/2024
Date Signed: 09/25/2024 04:20:41 PM

Document Has Been Signed on 09/25/2024 04:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LLCFACILITY NUMBER:
198603595
ADMINISTRATOR/
DIRECTOR:		VALDEZ, ABRAHAMFACILITY TYPE:
735
ADDRESS:301 PARKWOOD LNTELEPHONE:
(818) 240-4568
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY: 5CENSUS: 4DATE:
09/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Giovanni AngelesTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
NARRATIVE
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At 2:00 p.m. on 09/25/24 Licensing Program Analyst (LPA) Nicholas Reed and Licensing Program Manager (LPM) Naira Margaryan conducted an unannounced case management visit. LPA and LPM met with the administrator and disclosed the reason for the visit.

This case management visit was conducted in conjunction with complaint investigation #31-AS-20240318122411 to address deficiencies unrelated to the complaint.


During the initial complaint investigation, LPA Nicholas Reed was informed by the Administrator that Staff #1 (S1) was fired based on the outcome of the complaint investigation conducted by the Licensing Office and Regional Center. Upon further discussion LPA was informed that the Administrator spoke with other facility staff, and they provided the information that could be grounds for termination.
The Administrator did not document his communication with other staff to support his decision to terminate S1. He was advised to provide written declaration to the Licensing office explaining the reasons leading S1’s termination. At the time of investigation LPA also noted that the facility staff had knowledge of internal incidents that could pose hazard to the residents’ health, safety, and personal rights. However, no staff member reported the issues to the Administrator. In addition, during the complaint investigation staff revealed that while S1 was absent, Staff #2 (S2) and Staff #3 (S3) provided shower assistance to all clients. When staff told them to turn around, each of them naturally bent over to touch their toes. That didn’t seem like a natural thing. S2 and S3 asked about it to the other staff working in different shifts and over the weekends and they all confirmed they noticed same thing. Although staff noticed something unusual, none of them reported the issue to the Administrator, and therefore the facility did not submit any incident reports or other required reports to the Licensing Division. At the time of this visit, the Administrator was informed that staff are not following reporting requirements and all failed to follow AB40 - Abuse Reporting Requirements. Deficiencies are cited on the corresponding 809-D page.

No immediate health or safety hazards 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: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 09/25/2024 04:20 PM - It Cannot Be Edited


Created By: Nicholas Reed On 09/25/2024 at 03:57 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: PARKWOOD HOME LLC
FACILITY NUMBER: 198603595

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/04/2024
Section Cited
CCR
80061(b)(1)(F)

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WIC 15630(b)(1) - A mandated reporter who... has knowledge of an incident that reasonably appears to be physical abuse…abduction, isolation, … or neglect, shall report...immediately or as soon as practicably possible. This requirement was not met as evidenced by:
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The licensee has agreed to conduct an in-service training for all staff about the section cited. The licensee will submit proof of training by the POC due date.
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Based on interviews and record review, the licensee did not comply with the section cited above in all staff posing a potential Health, Safety, or Personal Rights risk to clients in care.
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Type B
10/04/2024
Section Cited
CCR85064(j)(2)

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85064 Adminstrator Qualifications and Duties (j) The administrator shall perform the following duties: (2) Development of an administrative plan and procedures to define lines of responsibility, workloads, and staff supervision. This requirement was not met as evidenced by:
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The licensee has agreed to conduct an in-service training for all staff about the section cited. The licensee will submit proof of training by the POC due date.
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Based on interviews and record review, the licensee did not comply with the section cited above in all staff posing a potential Health, Safety, or Personal Rights risk to clients 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.
SUPERVISOR'S NAME:Naira Margaryan
LICENSING EVALUATOR NAME:Nicholas Reed
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024


LIC809 (FAS) - (06/04)
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