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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608404
Report Date: 08/23/2023
Date Signed: 08/23/2023 04:49:59 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/17/2023 and conducted by Evaluator Antonia Alvizar
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230817154209
FACILITY NAME:VICTOR JEM HAPPY HOMESFACILITY NUMBER:
197608404
ADMINISTRATOR:NATHANIEL HEMEDESFACILITY TYPE:
740
ADDRESS:831 DELAWARE ROADTELEPHONE:
(818) 232-7561
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY:6CENSUS: 4DATE:
08/23/2023
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:TIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Staff threatened resident
Staff yelled at resident
Staff did not ensure that resident was adequately fed
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Antonia Alvizar conducted unannounced complaint visit to the facility. LPA met with Administrator and explained the purpose of this visit.

At 10:13AM LPA requested copies of staff and residents’ roster. At 10:35AM LPA Alvizar and Administrator conducted a physical plant inspection. Between 10:40AM – 1:45PM LPA Alvizar interviewed Administrator, three (3) staff, two (2) out of four (4) residents. Two (2) other residents were non-verbal.

Staff threatened and yelled at resident.
It is alleged that staff #1 (S1) threatened resident #1 (R1) and shouted at them. Resident interviews during this visit reveal that none of the staff threaten and yelled at residents. R1 had an incident in the past with a former caregiver but that staff no longer work in the facility. Staff interviews reveal that they do not threaten and/or yelled at residents. LPA Alvizar did not observe any staff threaten and yelling at residents.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
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 31-AS-20230817154209
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VICTOR JEM HAPPY HOMES
FACILITY NUMBER: 197608404
VISIT DATE: 08/23/2023
NARRATIVE
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(Continuation from 9099)

Based on interviews, and observation, there is an insufficient information to support the allegations. Therefore, the allegations are UNSUBSTANTIATED at this time.

Staff did not ensure that resident was adequately fed.

It was alleged that the caregiver never fed resident #1 (R1) after R1 told the caregiver they were hungry.

At 1:15PM, LPA Alvizar observed lunch being served and consist of the following: white rice, lumpia (egg rolls), steam fish, vegetables, grapes, water and/or tea. R1 was present during lunch time. LPA Alvizar observed R1 eating lunch. At 1:20PM LPA Alvizar spoke with R1 and R1 stated that they get adequate food, and they like it. Other residents did not address any concerns regarding food service assistance at the facility.

Based on inspection, observation and interviews, there is an insufficient information to support the allegation. Therefore, the allegation is deemed unsubstantiated at this time.

No immediate health and safety hazard is noted during this visit.

Exit interview conducted. Copy of report was provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2