567609958-10-25-2023-29-AS-DPEA-CX5PHX-20231031112041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609958
Report Date: 10/25/2023
Date Signed: 10/25/2023 04:03:52 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
12/02/2022 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20221202091141

FACILITY NAME:	TREMONT HOME CARE, INC.		FACILITY NUMBER:	567609958
ADMINISTRATOR:	GRAHAM, LISA		FACILITY TYPE:	735
ADDRESS:	6694 TREMONT CIRCLE		TELEPHONE:	(805) 553-8451
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY:	6	CENSUS: 3	DATE:	10/25/2023
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Lisa Graham		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility does not have adequate staffing to supervise residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to this facility today to deliver the investigation finding for the above allegation.

Following is a summary of the allegation and investigation finding:

On 12/02/2022, Community Care Licensing Division received a complaint alleging “Facility does not have adequate staffing to supervise residents in care”. It was reported that Ms. Graham forced Client #1 (C1) to be out of the home during certain times of the day when she needed to leave the house for either an appointment or other personal obligation.

On 12/05/2022, LPA Chochian conducted an unannounced inspection at the facility. Interview was conducted with Administrator Lisa Graham. Ms. Graham denied the allegation and stated that she does have adequate staff coverage. (continue to LIC9099c)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

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-20221202091141

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: 10/25/2023

NARRATIVE

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Ms. Graham denied ever forcing former client (C1) to leave the facility. Ms. Graham stated that if she had to leave the facility for an hour with clients, she would not need to contact staff. According to Ms. Graham they all coordinate and manage their appointments and errands. Ms. Graham stated that if a client does not want to go with her on errands for the facility or does not have any other planned activities then she will have staff cover until she returns. Regarding the incident with the former client (C1), Ms. Graham stated that she never forced C1 to leave the home. Ms. Graham stated that her home is like “a family setting and we all do things together – no one is forced”. Ms. Graham stated that she and the other two clients were going to pick up something for one of the clients last week (11/28/22) and C1 didn’t want to go out with them. C1 chose to go watch a movie instead. According to Ms. Graham she didn’t force C1 to go watch a movie. Ms. Graham stated if needed she does have staff on call to contact for coverage.

On 02/16/2023 at approximately 11am and 02/24/2023 at approximately 1pm, the case was discussed with other potential witness. C1 and responsible person for C1 did not observe and were not aware of an alternative staff in the home to provide supervision. There appeared to be conflicting information and no evidence to clearly indicate a violation. The two other clients in the home were approached by LPA during the initial visit on 12/05/2022 however both declined to interview but did state that they are doing well and like the facility. During other previous visits to the home Clients never voiced any issues, did not seem fearful and seem to be comfortable and happy with the home setting. Facility personnel records reviewed on 12/05/2023 and 2/16/2023 did show facility having alternative staffing available.

Based on the information obtained, there is insufficient evidence to support the allegation. Therefore, the allegation of "Facility did not have adequate staffing to supervise residents in care” is unsubstantiated at this time.

Exit interview conducted and copy of report provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

LIC9099 (FAS) - (06/04)

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