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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 421703549
Report Date: 06/14/2023
Date Signed: 06/14/2023 05:15:27 PM

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
01/24/2023 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20230124170445
FACILITY NAME:DEVEREUX FOUNDATION - WEISMAN CENTER (RCFE)FACILITY NUMBER:
421703549
ADMINISTRATOR:ENEDILIA AVILAFACILITY TYPE:
740
ADDRESS:6960 DEVEREUX WAYTELEPHONE:
(805) 879-0338
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:15CENSUS: 15DATE:
06/14/2023
UNANNOUNCEDTIME BEGAN:
12:39 PM
MET WITH:Omar Garcia, Program ManagerTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Staff did not meet resident's hyigene/grooming needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kristin Kontilis conducted a subsequent complaint visit to issue final findings for the complaint allegation above. LPA met with Omar Garcia, Program Manager and Monica Gomez, Clinical Case Manager. LPA explained the purpose of the visit. During the investigation, on 6/14/2023, LPA reviewed relevant documents for R1, conducted interviews with staff at 12:41 pm, 12:48 pm, 12:52 pm, 12:55 pm, and 4:40 pm, and conducted interviews with residents at 2:08 pm, 2:09 pm, 2:12 pm, and 2:15 pm.
On the allegation: Staff did not meet resident's hygiene/grooming needs. It was alleged that R1 appeared “disheveled” with hair growing out of their nose, had an unkempt beard, hair growing out of their ears and wax in the ears. Staff told the reporting party they could not force R1 to shower or help with grooming if R1 refused.
Interviews with residents at the facility revealed the staff help them with hygiene and grooming needs, and their needs are being met. Interviews with staff at the facility revealed they help residents with hygiene and grooming needs, but respect residents if they want to refuse care. Staff indicated if residents
Please refer to 809-C, Pg 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
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 29-AS-20230124170445
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: DEVEREUX FOUNDATION - WEISMAN CENTER (RCFE)
FACILITY NUMBER: 421703549
VISIT DATE: 06/14/2023
NARRATIVE
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refuse, they will request assistance from other staff and the other staff is usually successful in encouraging the client to comply with hygiene and grooming tasks. Staff stated they will continue to offer different staff to assist with showers or different times for showers. Once all options have been used for hygiene needs, the staff documents the refusal on the shower log with signature and the attempts that have been made. LPA also interviewed a witness who indicated they were unaware of staff neglecting hygiene and grooming needs.

Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. No deficiencies noted. Copy of report issued at the time of the visit.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2