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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567609958
Report Date: 03/25/2022
Date Signed: 03/25/2022 10:56:23 AM

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
07/28/2021 and conducted by Evaluator Zabel Chochian
COMPLAINT CONTROL NUMBER: 29-AS-20210728160352
FACILITY NAME:TREMONT HOME CARE, INC.FACILITY NUMBER:
567609958
ADMINISTRATOR:GRAHAM, LISAFACILITY TYPE:
735
ADDRESS:6694 TREMONT CIRCLETELEPHONE:
(805) 553-8451
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:6CENSUS: 2DATE:
03/25/2022
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Lisa GrahamTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Clients were left unsupervised
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to deliver findings for the above allegation that were investigated by LPA KaSandra Lopez. LPA Chochian met with Administrator Lisa Graham at 8:30am and explained the reason for the visit. Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QAS) Katy Robison was also present.
On 07/28/2021, The Department received a complaint regarding Neglect and Lack of Supervision. It was alleged that clients are left unsupervised. On 08/06/21, LPA Lopez conducted the initial inspection. QAS Freddie Garcia was also present. Between 10:18 AM and 11:20 AM interviews were conducted with the Administrator, Client #1 (C1) and Client #2 (C2).
On 10/01/2021, a subsequent inspection was conducted with LPA Lopez, QAS Garcia, and LPA Martha Guzman-Chavez being present. Beginning at 10:25 AM, facility records were reviewed, and an interview was conducted with C1 at 11:29 AM. An interview with Client #3 (C3) was attempted but C3 declined to be interviewed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022
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-20210728160352
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: TREMONT HOME CARE, INC.
FACILITY NUMBER: 567609958
VISIT DATE: 03/25/2022
NARRATIVE
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On 11/09/2021, A Collateral inspection was conducted and between 12:07 PM and 2:09 PM and C1, C2, and C3 were interviewed. Multiple telephone interviews were also conducted with Individual #1 (I1) through out the investigation.

Information obtained during the course of the investigation revealed the facility is a level two group home and the clients are able to sign out and leave the home unassisted. Interviews revealed the three clients in the home attend activities together outside the home of which during this time, the Administrator may be running errands. Interviews revealed no issues or concerns regarding this practice.
Based on the information obtained, the Department does not have sufficient evidence to support the above allegation. Therefore, the above allegation is deemed Unsubstantiated at this time.

Exit interview conducted and report reviewed with the Administrator. A copy of the report and appeal rights will be issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2