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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567609958
Report Date: 12/08/2022
Date Signed: 12/08/2022 01:45:41 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
11/02/2021 and conducted by Evaluator Kasandra Lopez
COMPLAINT CONTROL NUMBER: 29-AS-20211102120656
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:
12/08/2022
UNANNOUNCEDTIME BEGAN:
12:07 PM
MET WITH:Lisa GrahamTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Licensee does not allow resident to have visitors
Facility staff restricted access to residents personal belongings
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) KaSandra Lopez conducted a subsequent complaint visit to deliver findings for the above noted allegations that were investigated by LPA Teresa Camara. LPA Lopez met with administrator Lisa Graham and explained the reason for the visit. Tri-Counties Regional Center (TCRC) Quality Assurance Specialists (QAS) Katy Robison and Ryan Landseadel were also present.

On 11/02/2021, The Department received a complaint indicating the licensee did not allow clients to have visitors and facility staff restricted clients access to their personal belongings (specifically cellphones).

On 11/09/2021, LPA Camara conducted investigative interviews and a visit to the facility. LPA conducted interviews with Client #1 (C1), Client #2 (C2), and Client #3 (C3) between 12:07 p.m. and 2:45 p.m.
Report continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
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-20211102120656
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: 12/08/2022
NARRATIVE
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All three clients confirmed visitors could come to the facility but must call ahead and can only visit in the backyard while social distancing and wearing masks due to COVID-19 restrictions. Therefore, the allegation that the licensee does not allow clients to have visitors is deemed UNSUBSTANTIATED at this time.

C1 confirmed they stored their cellphone in their own room. C2 and C3 stated at night they store their cellphones at a charging station adjacent to the kitchen, so they don’t stay up late at night on their phones. They also store their phones at the charging station during remote-learning day program, so they are not distracted. Both C2 and C3 were comfortable storing their phone at the charging station and both felt it would be ok if they chose not to do so. Therefore, the allegation facility staff restricted clients access to their personal belongings is deemed UNSUBSTANTIATED at this time.

Exit interview conducted and report reviewed with the administrator. A copy of the report was emailed to the licensee.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2