565800884-8-29-2024-29-AS-DPEA-D9HNFN-20240927102550

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565800884
Report Date: 08/28/2024
Date Signed: 08/29/2024 04:48:24 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
10/13/2023 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20231013151652

FACILITY NAME:	SIMI OAKS COUNSELING GROUP		FACILITY NUMBER:	565800884
ADMINISTRATOR:	ERNEST W. FEDERER, PHD		FACILITY TYPE:	775
ADDRESS:	2345 ERRINGER ST., STE 106		TELEPHONE:	(805) 581-4357
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	50	CENSUS: 22	DATE:	08/28/2024
		UNANNOUNCED	TIME BEGAN:	11:18 AM
MET WITH:	Ernest Federer		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff administer unauthorized medication to client

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to deliver investigation finding to the allegation above. Upon arrival LPA met with Ernest Federer and reason for the visit was explained.

On 10/13/2023, Community Care Licensing Division received the above complaint allegation. It was alleged that Executive Director Ernest Federer and other facility staff administer “secret PRN”, unauthorized medication to client #1 (C1). Report was made that when C1 is having a behavioral episode staff are instructed by the ED to give C1 the “yellow pill”.

LPA and Ryan Landseadel, Quality Assurance Specialist (QA) with the Tri-Counties Regional Center (TCRC), conducted initial visit to the day program on 10/19/23 to initiate investigation into above allegation. At approximately 9:45am interview was conducted with staff; LPA and staff reviewed medications on hand at approximately 10:45am. Facility is storing and administering medication for five clients. (Cont. to LIC9099c).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

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 29-AS-20231013151652

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: SIMI OAKS COUNSELING GROUP	FACILITY NUMBER: 565800884
	VISIT DATE: 08/28/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

All five client medications were reviewed. There were no medications stored for C1. Staff reported that C1 is not provided with any medication at the day program.

LPA and Ryan Landseadel, QA from TCRC, conducted A subsequent visit was conducted on 12/19/2023, at approximately 10:45am, LPA reviewed client and staff files. Between 12pm-1:15pm, interview was conducted with clients and staff. Copies of pertinent records obtained. Additional interviews were conducted with C1, and behaviorist. C1 liked attending this day program; did not recall if staff ever provide any medication or a tic tac. Other potential witnesses’ interview did not witness staff or ED give any PRN medication or tic tac to C1. Four out five staff interviewed denied the allegation; medtech reported that C1 did not have any medications therefore was not receiving medication assistance at the day program. ED denied the allegation and stated that C1 was not given any medication. ED reported that C1’s home staff did not provide any PRN medication. Therefore, when C1 would exhibit increased behavioral episode, ED would give C1 a “yellow Tic-Tac” because C1 would ask for PRN medication.

Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation "Staff administer unauthorized medication to client” is deemed UNSUBSTANTIATED at this time.

Exit interview is conducted. Copy of report and appeal rights provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2