197608661-9-16-2022-29-AS-JAPL-CJJPXE-20220923114213

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608661
Report Date: 09/16/2022
Date Signed: 09/16/2022 11:15:23 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
04/29/2022 and conducted by Evaluator Elsie Campos

COMPLAINT CONTROL NUMBER: 29-AS-20220429164803

FACILITY NAME:	ELWYN NC - KELVIN 1		FACILITY NUMBER:	197608661
ADMINISTRATOR:	BRANDY C MAYNARD		FACILITY TYPE:	735
ADDRESS:	5651 KELVIN AVE		TELEPHONE:	(747) 900-6742
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	4	CENSUS: 4	DATE:	09/16/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Administrator-Brandy Maynard		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff uses illegal drugs in the facility.
Staff offers illegal drugs to residents.
Staff beats the residents.
Staff restrains the residents by locking them in their room.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elsie Campos conducted a subsequent complaint visit to deliver findings for the above allegations. The LPA met with Staff and spoke to Administrator Brandy Maynard over the phone and explained the reason for the visit. Administrator Brandy Maynard authorized Staff Linz N. Owor to sign the report.

Allegation: Staff uses illegal drugs in the facility

On 04/29/2022, the Department received a complaint alleging staff uses illegal drugs at the facility. The complaint was referred to the Community Care Licensing (CCL) Investigations Branch (IB) on 5/3/2022 and assigned to Investigator Christine Ferris.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

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 5

Control Number 29-AS-20220429164803

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: ELWYN NC - KELVIN 1	FACILITY NUMBER: 197608661
	VISIT DATE: 09/16/2022

NARRATIVE

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On 05/03/2022, from 10:40 a.m. to 12:27 p.m., Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced initial 10-day complaint visit at the facility regarding the above allegation. LPA Camara met with Brandy Maynard, Administrator and explained the reason for the visit. During the inspection, the LPA conducted a physical plant tour with staff at 10:41 a.m., conducted a record review beginning at 10:53 a.m. and interviewed two (2) staff. The LPA was provided records for three (3) staff and obtained pertinent copies. The Administrator was notified that the complaint needed further investigation to determine findings for the above allegation.

On 05/9/2022, Investigator Ferris conducted interviews with Client #1 (C1); on 05/16/2022, Investigator Ferris conducted interviews with Client #2 (C2), Client #3 (C3), Client #4 (C4) and facility staff. All clients denied knowledge of illegal drug use or offers to participate in illegal drug use by staff and or other clients at the facility.

Interviews conducted with clients by Investigator Ferris revealed that clients have never seen staff use illegal drugs in the facility. The facility’s population consists of clients who are verbal and aware of their surroundings and would not hesitate to make such allegations known, if they were valid. It is suspected that Staff #1 (S1) was targeted by a disgruntled former employee when these allegations were brought to the attention of the department. Additionally, interviews conducted by the LPA with staff denied claims that anyone at the facility has engaged in illegal drug use. Staff also denied claims that they have ever heard or seen S1 using illegal drugs. An interview with S1 also confirmed that they have never used illegal drugs at the facility. Based on interviews which were conducted, there is insufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 29-AS-20220429164803

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: ELWYN NC - KELVIN 1	FACILITY NUMBER: 197608661
	VISIT DATE: 09/16/2022

NARRATIVE

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Allegation: Staff offers illegal drugs to residents

On 04/29/2022, the Department received a complaint alleging staff offers illegal drugs to clients in care. The complaint was referred to the Community Care Licensing (CCL) Investigations Branch (IB) on 5/3/2022 and assigned to Investigator Christine Ferris.

On 05/03/2022, from 10:40 a.m. to 12:27 p.m., Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced initial 10-day complaint visit at the facility regarding the above allegation. LPA Camara met with Brandy Maynard, Administrator and explained the reason for the visit. During the inspection, the LPA conducted a physical plant tour with staff at 10:41 a.m., conducted a record review beginning at 10:53 a.m. and interviewed two (2) staff. The LPA was provided records for three (3) staff and obtained pertinent copies. The Administrator was notified that the complaint needed further investigation to determine findings for the above allegation.

On 05/9/2022, Investigator Ferris conducted interviews with the Client #1 (C1); on 05/16/2022, Investigator Ferris conducted interviews with Client #2 (C2), Client #3 (C3), Client #4 (C4) and facility staff. All clients and staff denied knowledge of staff offering illegal drugs to clients at the facility.

Interviews conducted with clients by Investigator Ferris revealed that clients have never been offered illegal drugs by staff. The facility’s population consists of clients who are verbal and aware of their surroundings and would not hesitate to make such allegations known if they were valid. It is suspected that Staff #1 (S1) was targeted by a disgruntled former employee when these allegations were brought to the attention of the department. Additionally, interviews conducted by the LPA with staff denied claims that anyone at the facility has ever seen anyone either staff or clients bring or offer illegal drugs at the facility. Staff also denied claims that they have ever heard or seen S1 offering drugs to clients. An interview with S1 also confirmed that they have never brought or offered illegal drugs to clients at the facility. Based on interviews which were conducted, there is insufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 29-AS-20220429164803

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: ELWYN NC - KELVIN 1	FACILITY NUMBER: 197608661
	VISIT DATE: 09/16/2022

NARRATIVE

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Allegation: Staff beats the residents

On 04/29/2022, the Department received a complaint alleging staff beats the clients in care. The complaint was referred to the Community Care Licensing (CCL) Investigations Branch (IB) on 5/3/2022 and assigned to Investigator Christine Ferris.

On 05/03/2022, from 10:40 a.m. to 12:27 p.m., Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced initial 10-day complaint visit at the facility regarding the above allegation. LPA Camara met with Brandy Maynard, Administrator and explained the reason for the visit. During the inspection, the LPA conducted a physical plant tour with staff at 10:41 a.m., conducted a record review beginning at 10:53 a.m. and interviewed two (2) staff. The LPA was provided records for three (3) staff and obtained pertinent copies. The Administrator was notified that the complaint needed further investigation to determine findings for the above allegation.

On 05/9/2022, Investigator Ferris conducted interviews with the Client #1 (C1); on 05/16/2022, Investigator Ferris conducted interviews with Client #2 (C2), Client #3 (C3), Client #4 (C4) and facility staff. All clients denied any knowledge of staff beating the clients.

Interviews conducted with clients by Investigator Ferris revealed that clients have never been beat by staff. The facility’s population consists of clients who are verbal and aware of their surroundings and would not hesitate to make such allegations known if they were valid. It is suspected that Staff #1 (S1) was targeted by a disgruntled former employee when these allegations were brought to the attention of the department. Additionally, interviews conducted by the LPA with staff denied claims that anyone at the facility has ever used violence, force or hit a client. Staff revealed that when there is a need to correct client behavior, they do so by using calm verbal redirection with the clients or redirecting them to another area when behaviors have escalated to ensure the safety of the other clients. Staff also denied claims that they have ever heard or seen S1 hit a client. An interview with S1 also confirmed that they have never used violence or hit a client at the facility and also confirmed that they use calm verbal redirection when addressing a client. Based on interviews which were conducted, there is insufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 29-AS-20220429164803

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: ELWYN NC - KELVIN 1	FACILITY NUMBER: 197608661
	VISIT DATE: 09/16/2022

NARRATIVE

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Allegation : Staff restrains the residents by locking them in their room

On 04/29/2022, the Department received a complaint alleging staff restrain clients in care by locking them in their room. The complaint was referred to the Community Care Licensing (CCL) Investigations Branch (IB) on 5/3/2022 and assigned to Investigator Christine Ferris.

On 05/03/2022, from 10:40 a.m. to 12:27 p.m., Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced initial 10-day complaint visit at the facility regarding the above allegation. LPA Camara met with Brandy Maynard, Administrator and explained the reason for the visit. During the inspection, the LPA conducted a physical plant tour with staff at 10:41 a.m., conducted a record review beginning at 10:53 a.m. and interviewed two (2) staff. The LPA was provided records for three (3) staff and obtained pertinent copies. The Administrator was notified that the complaint needed further investigation to determine findings for the above allegation.

On 05/9/2022, Investigator Ferris conducted interviews with the Client #1 (C1); on 05/16/2022, Investigator Ferris conducted interviews with Client #2 (C2), Client #3 (C3), Client #4 (C4) and facility staff. All clients denied that staff restrains them by locking them in their room.

Interviews conducted revealed that staff do not restrain clients by locking them in their room. The facility’s population consists of clients who are verbal and aware of their surroundings and would not hesitate to make such allegations known if they were valid. It is suspected that Staff #1 (S1) was targeted by a disgruntled former employee when these allegations were brought to the attention of the department. Additionally, interviews conducted by the LPA with staff denied claims that anyone at the facility has ever restrained a client or locked them in their room. Staff revealed that when clients are in their room, they have no restrictions of when they can enter or exit. Staff also denied claims that they have ever heard or seen S1 restrain a client or lock them in their room. An interview with S1 also confirmed that they have never locked a client in their room or restrained a client in any way. LPA Campos checked the client’s bedroom doors while at the facility and found that they did not have locks on the doors. Based on interviews which were conducted, there is insufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

LIC9099 (FAS) - (06/04)

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