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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850543
Report Date: 09/12/2024
Date Signed: 09/12/2024 09:38:26 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/02/2024 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20240802140422
FACILITY NAME:YOUNG ADULT FAMILY HOMEFACILITY NUMBER:
405850543
ADMINISTRATOR:D0LLY SCHWEDFACILITY TYPE:
735
ADDRESS:1949 L STREETTELEPHONE:
(805) 423-8902
CITY:SAN MIGUELSTATE: CAZIP CODE:
93451
CAPACITY:4CENSUS: 2DATE:
09/12/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Licensee, Diane YoungTIME COMPLETED:
10:26 AM
ALLEGATION(S):
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Licensee did not notify clients responsible party of new facility location.
Licensee did not allow clients to eat dinner in the dining room with the other clients.
Staff did not ensure the food was of good quality.
Licensee did not allow clients to have visitors in the facility.
Licensee did not allow clients to leave the facility.
Licensee did not ensure clients personal privacy during phone calls.
INVESTIGATION FINDINGS:
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 At 7:45am on 09/12/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to issue final findings to all the allegations to this complaint. LPA met with Administrator, Diane Young and explained the reason for the visit.

As to the allegations of, “Licensee did not notify clients responsible party of new facility location.”, “Licensee did not allow clients to have visitors in the facility.”, and “, “Licensee did not allow clients to leave the facility.” It was alleged that, Licensee never informed Family Member (F1) when facility relocate to a new facility location and did not allow Clients 1 and 2 (C1 and C2) to leave the facility or have visitors. It was discovered through interviews and documentation that; on 08/08/2024, Licensing Program Analyst (LPA) Jeffries reviewed Client 1 (C1) and Client 2 (C2), Admissions Agreements, Individual Personal Plans, LIC602 (Physicians Reports) that were singed by clients. No documentation reviewed or presented indicated that C1 and C2 were subject to the terms of a Power of Attorney (POA) or under Conservatorship.
CONTINUED on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
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 3
Control Number 29-AS-20240802140422
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: YOUNG ADULT FAMILY HOME
FACILITY NUMBER: 405850543
VISIT DATE: 09/12/2024
NARRATIVE
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 LPA Jeffries conducted interview of F1 on 08/07/2024, where F1 stated that C1 and C2 were independent to make their own decisions and were not subject to conservatorship of any kind. F1 stated that C1 and C2 had family visits with F1 on the following dates, one unspecified date in 2022, April 4th, 2023, May 12th-15th 2023, Day visit in August of 2023, and July of 2024, to F1’s recollection. F1 stated that Administrator had invited F1 to new facility location by phone but did not meet C1 and C2 at the other facility locations. Interview of Licensee, Diane Young on 08/08/2024, Licensee stated that C1 and C2 did not have a POA or conservatorship and were both independent adults who made their own decisions and not required by regulations to notify relatives of facility change of location. Licensee stated that they had invited F1 to come to the current facility to visit C1 and C2 but could not recall the date of the invite that was offered over the telephone and that F1 declined the visit at that time. On 08/09/2024, LPA Jeffries conducted an interview with Witness 1 (W1) who stated that C1 and C2 were both considered independent adults that make their own decisions and sign their own forms. W1 stated that visitations with C1 and C2 were mostly facilitated by Day Programs or Facility facilitating dropping C1 and C2 off at a designated location due to far travel distances. On 08/15/2024, LPA Jeffries interviewed C1 and C2, both stated that they had been on several visits with F1 over the past 3 years. Based on documentation and interviews it was discovered that C1 and C2 were independent Adults, and both C1 and C1 did not require or have an identified responsible party and had several visits away from the facility. At this time there is not enough evidence to support the allegation of, “Licensee did not notify clients responsible party of new facility location.” “Licensee did not allow clients to have visitors in the facility.”, and “, “Licensee did not allow clients to leave the facility.” and is unsubstantiated at this time.
As to the allegations of, “Licensee did not allow clients to eat dinner in the dining room with the other clients.” and “Staff did not ensure the food was of good quality.” It was alleged that, C1 and C2 were not allowed to sit in dining room with other clients and were serve low quality food like canned ravioli, cereal, and macaroni and cheese, chicken nuggets, and fast food. It was discovered through interviews and observations. On 08/15/2024, LPA Jeffries conducted interviews with C1 and C2, both stated that they sometimes would eat at the dinner table and sometimes eat in their room. C1 and C2 both stated that they did have a choice of where they ate their meals. Both C1 and C2 stated that the facility food was good. Both stated they enjoy fast food.

CONTINUED on LIC9099-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 29-AS-20240802140422
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: YOUNG ADULT FAMILY HOME
FACILITY NUMBER: 405850543
VISIT DATE: 09/12/2024
NARRATIVE
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On 08/08/2024, LPA Jeffries interviewed Licensee Diane Young, who denied that C1 and C2 were ever forced to eat in their rooms. LPA Jeffries conducted 10 facility visits from 09/01/22 through 08/08/2024, LPA observed on 10 of 10 visits to the facility that the food quality met or exceeded regulations standards for food (85076 and 80076). On 7 of 10 of those facility visits by LPA Jeffries, LPA observed C1 and C2 sitting with peers and eating meals at the dinner table. At this time there in not enough evidence to support the allegations of, “Licensee did not allow clients to eat dinner in the dining room with the other clients.” and “Staff did not ensure the food was of good quality.” and are both unsubstantiated at this time.

As to the allegation of, “Licensee did not ensure clients personal privacy during phone calls.” It was alleged that, C1 and C2 were never allowed to have private phone calls and were always on speaker phone. It was discovered by interviews and observations that on 08/15/2024, LPA Jeffries conducted interviews with C1 and C2 who both stated they had use of the facility phone when they desired. C1 was aware that the facility phone was wireless and could be moved to a more private location in the facility. On 08/08/2024, LPA Jeffries conducted an interview with Administrator Diane Young, who stated that C1 and C2 would take calls together on speaker phone so they both could participate in the phone call and did not request to move the mobile phone. Administrator stated that C1 and C2 choose to take calls on the speaker phone in the living room areas. Administrator stated that all clients are free to use the wireless phone when desired for privacy, clients choose where they wish to use the phone. LPA Jeffries observed a wireless facility phone on multiple visits to the facility. At this time there is not enough evidence to support the allegation of, “Licensee did not ensure clients personal privacy during phone calls..” and is unsubstantiated at this time.

Exit interview, report read, and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3