565850261-10-31-2023-29-AS-DPEA-CX5TF9-20231031144110

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850261
Report Date: 10/31/2023
Date Signed: 10/31/2023 01:43:47 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
09/19/2022 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20220919114801

FACILITY NAME:	ABOVE AND BEYOND HOME CARE		FACILITY NUMBER:	565850261
ADMINISTRATOR:	SALUNGA, ALBERT		FACILITY TYPE:	740
ADDRESS:	6217 ANASTASIA ST		TELEPHONE:	(747) 210-1660
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY:	6	CENSUS: 5	DATE:	10/31/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Albert Salunga		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff locked residents in the bathroom while in care.
Staff acted inappropriately with other staff member in the presence of resident in care.
Staff are sleeping in vacant resident room and common areas.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to the facility. The purpose of the visit is to conclude an investigation initiated by LPA Martha Arroyo on 09/20/2022. Upon arrival LPA met with staff and explained the reason for the visit. Staff contacted Licensee/Administrator who arrived shortly after LPA. Reason for visit was discussed with Mr. Albert Salunga.

On 09/19/2022, Community Care Licensing Division received the above complaint allegations. Investigation into the allegations consist of records review on 09/20/2022, from 1:45-3 p.m. and 10/25/2023; interviews with staff, residents, and other potential witness on 05/14/2023 from approximately 11 a.m. – 2 p.m. and 10/25/2023, from approximately 11:45 a.m. - 2:30 p.m. Additional pertinent records were obtained and reviewed on 10/25/2023. Following is a summary of the allegations and investigation:

Allegations) Staff locked resident in the bathroom while in care and staff acted inappropriately with staff member in the presence of the resident in care: (continue to LIC9099c)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220919114801

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: ABOVE AND BEYOND HOME CARE	FACILITY NUMBER: 565850261
	VISIT DATE: 10/31/2023

NARRATIVE

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It was reported that on 08/18/2022 at approximately 8:00 a.m., Staff #1 (S1) was providing care in the bathroom to Resident #1 (R1) and when Staff #2 (S2) entered the bathroom and locked the door. It was further reported that S2 made inappropriate comments and touched S1 inappropriately and forced self onto S1. It was also alleged that when S2 locked the bathroom door R1 and S1 could not exit out the bathroom until S2 unlocked the door and left.

Per the Personnel Schedule (LIC500) dated 06/01/2023, S1 was on schedule to work from 9 a.m.- 6 p.m. and S2 was on schedule to work the evening shift from 5 p.m. – 7 p.m. on alleged date of incident Thursday, 08/18/2022. However, although S2 was scheduled to be at the facility on the day of the alleged incident, interviews conducted reflected that S2 was not present during the alleged date/time of incident and instead was at an appointment with Staff #3 (S3). Additionally, S2 denied every speaking or making any inappropriate comments to S1. S2 further expressed that whenever S1 needed assistance providing care to residents in the bathroom, S2 would close the bathroom door to ensure residents are accorded privacy. During the course of the investigation, LPA attempted to contact S1 for interview on 5/14/2023 at approximately 11 a.m. , at 3 p.m. and 10 a.m. on 10/25/2023, however was not successful. Interviews conducted with other staff, residents and witnesses reflected that no residents were locked in the bathroom, nor had they ever witnessed any inappropriate comments/behavior by S2.

Moreover, LPA obtained and reviewed a copy of the police report from the Simi Valley Police Department. The police report reviewed on 10/25/2023, confirmed that due to conflicting statements coupled with a lack of evidence indicated probable cause was not met to indicate a crime occurred. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegations or that a violation occurred; therefore, the above allegations “staff locked resident in the bathroom while care” and “staff acted inappropriately with staff member in the presence of the resident in care” is deemed UNSUBSTANTIATED at this time.

Allegation) Staff are sleeping in vacant resident room and common areas: It was alleged that staff are sleeping in the vacant room and common areas of the facility. Regarding this allegation staff were interviewed and denied the allegation. S2 stated that when the facility was under “A Loving Care Villa” staff did have a designated room. However, when S2 took over the facility all rooms were cleared for residents; therefore, staff were informed that they no longer stay at the facility. According to S2 the staff who were live- ins prior to the Change of Ownership (CHOW) quit because of that change. (Continue to LIC9099c)

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220919114801

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: ABOVE AND BEYOND HOME CARE	FACILITY NUMBER: 565850261
	VISIT DATE: 10/31/2023

NARRATIVE

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Staff schedules obtained on 09/20/2022 and 10/25/2023 revealed 24/7 staff coverage. Staff and residents interviewed indicated staff do not sleep in common areas or in vacant resident rooms. During facility visit on 10/25/2023, LPA observed facility resident rooms to be fully occupied by residents.

Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the above allegation “Staff are sleeping in vacant resident room and common areas” is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

LIC9099 (FAS) - (06/04)

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