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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802457
Report Date: 09/24/2024
Date Signed: 09/24/2024 12:27:37 PM

Substantiated


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
03/18/2024 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20240318095900
FACILITY NAME:KESHER OLAMFACILITY NUMBER:
565802457
ADMINISTRATOR:HERSHKOVITZ, CAMIFACILITY TYPE:
735
ADDRESS:4234 HITCH BLVDTELEPHONE:
(805) 306-0606
CITY:MOORPARKSTATE: CAZIP CODE:
93021
CAPACITY:8CENSUS: 4DATE:
09/24/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Cami HershkovitzTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff violated client’s personal rights.
Staff did not afford a client respect in their relationship.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. LPAs M. Arroyo and B. Thomas conducted an initial complaint visit on 03/22/2024, LPAs M. Arroyo and B. Balisi along with Tri-Counties Regional Center Quality Assurance Specialist (QAS) Liz Aced-Arnett attempted a subsequent visit on 04/22/2024 and conducted a subsequent visit on 04/24/2024. On today's visit, LPA Arroyo met with Administrator, Cami Hershkovitz. Entrance interview.

During the initial visit on 03/22/2024, LPAs Arroyo and Thomas toured the facility at 9:32 a.m., conducted an interview with the Administrator at 9:10 a.m., conducted a client file review at 9:20 a.m., and obtained copies of pertinent documents.

Report Continued on LIC 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
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 4
Control Number 29-AS-20240318095900
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: KESHER OLAM
FACILITY NUMBER: 565802457
VISIT DATE: 09/24/2024
NARRATIVE
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Report Continued from LIC 9099...

On 04/24/2024, LPAs Arroyo and Balisi along with QAS Aced-Arnett conducted interviews with the administrator, one staff member, and three clients between 2:10 p.m. and 3:35 p.m. On 04/16/2024, LPA Arroyo and QAS Aced-Arnett conducted a collateral visit Arc VC-Cochran and conducted interviews with two staff members and one client between 9:54 a.m. and 11:00 a.m.

It was alleged that staff violated client’s personal rights and staff did not afford a client respect in their relationship. It was reported that facility staff has gone through Client #1’s (C1’s) bag after arriving from program, taken things out, and not giving them back. Records review and interviews conducted revealed that facility inspect C1’s bag after arriving from day program. Per resident notes, dated 03/13/2024, noted that C1 is required to hand over their bag immediately upon arrival, and staff then conduct a thorough inspection of its contents. This inspection process appears to be routine rather than selective and has included instances where items have been removed from the bag and not returned to C1. Additionally, facility staff has been sending notes to the day program in which it describes C1’s behavior, painting a negative picture of C1’s attitude. Further interviews conducted with staff revealed that C1 came home from day program with markers; however, the markers did not ‘look like’ the markers C1 has at home; therefore, the facility staff requested the day program personnel check C1’s personal locker and provide an inventory list to the facility staff. Though facility staff was continuously requested the day program staff have a communication book to disclose any issues the facility should be aware of and asking for C1’s inventory in their locker numerous times. The day program staff did not have any concerns with C1’s items in their locker and felt it unnecessary to create an itemized inventory of C1’s personal items. Further interviews conducted revealed that facility staff has been utilizing punitive measures by removing clients' Wi-Fi access as a “consequence” for various behavioral issues, including using inappropriate language, exhibiting a poor mood, or slamming doors. This action has resulted in clients losing access to their phones and iPads for extended periods, and has adversely impacted their ability to watch television, as their access to TV programming is dependent on internet connectivity.

Report Continued from LI C9099...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20240318095900
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: KESHER OLAM
FACILITY NUMBER: 565802457
VISIT DATE: 09/24/2024
NARRATIVE
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Report Continued fro LIC 9099C...

Based on the information obtained and reviewed during the course of the investigation, the Department has sufficient evidence to support the allegations of “staff violated client’s personal rights” and “staff did not afford a client respect in their relationship”. Therefore, these allegations are being deemed Substantiated at this time.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.

Exit interview was conducted with the Administrator Cami Hershkovitz. A copy of the report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20240318095900
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: KESHER OLAM
FACILITY NUMBER: 565802457
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/30/2024
Section Cited
CCR
80072(a)(1)
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80072(a)(1) each client shall have personal rights which include, but are not limited to, the following: To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by:
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The Licensee will do the following:Review Regulation 80072 – Personal Rights, conduct an in-house training with staff regarding clients’ personal rights and submit a statement of understanding of Regulation and submit to CCL no later than POC due date.
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Based on record review and interviews conducted, the licensee did not comply with the section cited above as facility staff are going through C1’s personal belongings and are sending notes referencing C1’s attitude negatively, which poses a potential personal rights risk to persons 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.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4