<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608641
Report Date: 12/06/2024
Date Signed: 12/06/2024 01:29:02 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
12/02/2024 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20241202170145
FACILITY NAME:PINK CORAL RESIDENCE IIFACILITY NUMBER:
197608641
ADMINISTRATOR:REY MEDELFACILITY TYPE:
740
ADDRESS:40343 N. 15TH STREET WESTTELEPHONE:
(661) 480-5985
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:6CENSUS: 6DATE:
12/06/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rey MedelTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure that resident's hygiene needs are being met while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/06/2024 Licensing Program Analyst (LPA), Melissa Spaeth conducted a complaint investigation at the above facility to address the following allegation(s). LPA Spaeth was met by the Administrator, Rey Medel. LPA explained the purpose of this visit was to review residents’ records, conduct interviews, and present findings. The Administrator confirmed there are six residents living in the facility.

LPA conducted a physical plant tour at 9:30 am until 9:55 am. LPA reviewed residents’ documents at 10:05 am until 10:45 am. LPA interviewed five residents (R1-R5) out of the six residents at 10:45 am until 11:15 am. LPA also interviewed three staff (S1-S3)

Continued 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
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-20241202170145
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: PINK CORAL RESIDENCE II
FACILITY NUMBER: 197608641
VISIT DATE: 12/06/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
out of eight staff at 11:40 am until 11: 55 am. LPA Spaeth requested a copy of the resident roster, staff work schedule (LIC 500), and copies of the residents’ documentation. LPA received the documentation during the visit.

Regarding the allegation: Staff do not ensure that resident's hygiene needs are being met while in care. It’s being alleged residents are not provided the daily care needed. R1-R5 residents confirmed the staff always provides the assistance to meet their daily needs. R1-R5 also confirmed when they ask staff for assistance, the staff always provides the assistance they need. R6 was unavailable for an interview. S1-S3 confirmed they assist residents with their daily needs and stated the residents have not complained about the service they provide.

Based upon resident and staff interviews, the allegation is unsubstantiated.

Exit interview conducted and a copy of the report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2