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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801526
Report Date: 04/10/2024
Date Signed: 04/11/2024 07:19:57 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
12/11/2023 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20231211155304
FACILITY NAME:PCS-SARANACFACILITY NUMBER:
565801526
ADMINISTRATOR:ALEX RENTERIAFACILITY TYPE:
735
ADDRESS:10325 SARANACTELEPHONE:
(805) 659-2673
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY:4CENSUS: 4DATE:
04/10/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jazmin De La TorreTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff is verbally and physically abuse toward residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent complaint visit to deliver findings for the allegation listed above. The LPA met with staff and explained the reason for the visit. Staff contacted the Administrator Didi Daniel on the phone and the LPA aspoke with the administrator and read the report to them. The Administartor gave permison to the facility representative to sign off on the report. Staff Jazmin De La Torre.

On 12/14/2023, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced complaint visit to investigate the allegation listed above. The LPA met with Lead staff Harold Daniel and facility representative at 10:40 a.m. and explained the reason for the visit. At 10:50 a.m. the LPA requested documents pertaining to the investigation. From 10:55 a.m. to 11:45 a.m. LPA Urena interviewed the administrator, staff, and residents. Further investigation was needed prior to issuing final findings.
Continues on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2024
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-20231211155304
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PCS-SARANAC
FACILITY NUMBER: 565801526
VISIT DATE: 04/10/2024
NARRATIVE
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Staff are verbally and physically abusive toward residents.
-On the allegation that staff yelled and physically abused Resident #1 (R1), the Reporting Party’s (RP) concern is that the staff violated the personal rights of the resident during an incident at the facility. The LPA interviewed the RP, who stated that R1 had complained to them about a Staff #1 (S1) and stated S1 kicked and pushed R1. Furthermore, R1 reported that S1 was also mean and rude to R1. The RP stated that they also observed a bruise on R1’s left lateral proximal calf.

-The LPA interviewed staff (S2), and they stated the following: On Thursday, 12/07/2023 at around 2:00 p.m. during snack time, R1 said to S2 'I like you guys", then said, ‘S1 kicked me" (the night before on 12/06/2023), then R1 pointed towards the left knee (top of the knee). R1 made a motion with their leg to demonstrate how S1 had kicked R1 on the knee. R1 was wearing shorts. S2 stated that they noticed a small light bruise on R1's left knee. However, S2 stated that it could have been from a prior incident which happened on 12/04/2023, when R1 bumped their knee against the wall. The bump happened when R1 was coming back from the day program, lost their balance and hit the wall with their left knee. S2 offered help to R1, but R1 declined help and said that they were OK. When LPA asked if R1 had complained of verbal abuse, or name calling to S2, S2 said, ‘No’. Per S2, R1 tends to say they don't like staff, when staff don't give R1 what they might want or request.

-The LPA interviewed staff (S3) who was on shift with S1 at the time of the alleged incident. S3 explained that R1 was refusing to shower and yelling at S1. S3 tried to assist S1 to convince R1 to take a shower after a bowel movement (BM) incident. S3 stated that they did not see S1 kick R1 and S1 did not yell expletives; however, R1 did yell expletives at S1. S3 added that R1 does not like S1 because S1 tells R1 to clean up ‘the messes’ and treats R1 like an “adult’.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20231211155304
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PCS-SARANAC
FACILITY NUMBER: 565801526
VISIT DATE: 04/10/2024
NARRATIVE
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The LPA interviewed the Administrator, who stated that they were informed of the statement made by R1 to S2 and added that an internal investigation was conducted by Human Resources (HR) department for the program ‘People Creating Success’. No new bruises were found where R1 claimed S1 had kicked R1, only an old, faded bruise from a previous fall.

-The LPA interviewed R1 and asked about bruises on their legs, and the R1 stated that they were ‘ok’. R1 stated they had hit the wall outdoors, but that they were ok. At the time of the LPA’s visit on 12/14/2023, R1 was wearing short pants, and was sitting on the living room couch with legs spread to the front and open to the sides. LPA observed both of R1' legs front and back, and neither exhibited bruises, injuries, or physical marks at the time of the visit. When asked about how they like the facility staff, R1 stated, ‘I like them’.

-The LPA attempted to interview (S1) on two occasions but was unable to reach them. The LPA received the facility’s Human Resources (HR) Internal Investigative Report, which included the interview conducted with S1. Per the interview conducted by the HR Director on 12/08/2023, S1 made a statement about the incident that led to the allegation and denied being abusive physically and verbally towards the R1.

-Record review of daily case notes, and behavioral assessments for R1, revealed maladaptive aggressive behavior towards staff and residents, and refusal to follow program directives.

Based on the information obtained through interviews, record review, and observation, there is not sufficient evidence to support the allegation that S1 kicked and verbally abused R1. Therefore, the allegation that staff are verbally and physically abusive toward residents, is deemed Unsubstantiated at this time.



Exit interview was conducted and a copy of the report was issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2024
LIC9099 (FAS) - (06/04)
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