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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609325
Report Date: 01/27/2023
Date Signed: 01/27/2023 01:33:58 PM

Substantiated


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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/26/2023 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20230126153041
FACILITY NAME:INDEPENDENT ENTERPRISE HEALTH CARE INCFACILITY NUMBER:
197609325
ADMINISTRATOR:JIM DURANDOFACILITY TYPE:
740
ADDRESS:36722 ROSE STTELEPHONE:
(661) 917-4380
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:4CENSUS: 4DATE:
01/27/2023
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Jim Durando, Administrator TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff are not wearing masks.
INVESTIGATION FINDINGS:
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At 11:10am Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced complaint visit to investigate the allegation above. LPA was greeted by Staff #1 (S1), who granted access to the facility. Upon arrival LPA was screened and LPA observed S1 wearing a mask. Administrator arrived shortly after and LPA explained the reason for the visit.

Interviews with the Administrator confirmed that sometime, around 07/14/22 & 12/21/22, a random visits were made by a credible witness who observed facility staff were not wearing masks. Administrator admitted that a verbal conversation with the credible witness took place on January 23rd, 2023 and a staff meeting regarding COVID protocols were held on 01/24/2023. Based on an interview conducted with the Administrator this allegation is Substantiated at this time.

Deficiencies were issued per CA code of Regulations Title 22 on LIC9099-D with this report. Appeal rights issued. Report signed and delivered. Exit interview conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
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-20230126153041
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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: INDEPENDENT ENTERPRISE HEALTH CARE INC
FACILITY NUMBER: 197609325
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/28/2023
Section Cited
CCR
87470(c)(1)(F)
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87470(c) Infection Control Requirements shall be developed by the licensee... (1) The Infection Control Plan shall include: (F) Staff shall demonstrate knowledge... appropriate to the job assigned and...

This requirement is not met as evidenced by:
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Licensee/Administrator agreed to provide in house training with all staff regarding Infection Control Requirements and COVID Protocol. A written statement signed by all staff regarding such training shall be emailed to LPA no later than 01/28/23.
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Based on an interview the licensee/administrator confirmed that during a previous visit conducted by the credible witness, staff did not comply with the section cited above by not wearing masks, which poses an immediate Health and Safety and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
LIC9099 (FAS) - (06/04)
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