Complaint Investigation Report

197690045-10-5-2021-29-AS-JAPL-CE6U8S-20220506152157

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD. #250

This is an official report of an unannounced visit/investigation of a complaint received in our office on

10/01/2021 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20211001081014

Uncleared adults providing care and supervision to clients.

Licensing Program Analyst (LPA) Ashley Smith arrived at unannounced for an initial complaint visit. The LPA met with Danielle Hage and explained the reason for the visit. During today’s visit, the LPA conducted a tour at 12:51 a.m., interviewed staff at 1:27 p.m. and 1:35 p.m., and reviewed documents.

Regarding the allegation, it was alleged that there were uncleared adults working at this location. At.2:30 p.m., the LPA spoke with the Operations Manager regarding whom was working at this location. The LPA compared the list to the Department clearance list and identified four employees (Staff #1, Staff #2, Staff #3, Staff #4) were working either without a clearance transfer or the clearance status was set to ‘Pending’. Based on interview and records review, this allegation is deemed Substantiated at this time. The facility was cited for this violation on 08/03/2021; additional civil penalties assessed.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

Exit interview conducted, today's reports and appeal rights were reviewed and issued.