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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609568
Report Date: 01/19/2022
Date Signed: 01/27/2022 09:36:48 AM

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
01/12/2022 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20220112171708
FACILITY NAME:BEWISE HOMEFACILITY NUMBER:
197609568
ADMINISTRATOR:OKONKWO, CHINWEIKEFACILITY TYPE:
740
ADDRESS:22214 VANOWEN STREETTELEPHONE:
(818) 300-4994
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91303
CAPACITY:6CENSUS: 3DATE:
01/19/2022
UNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:Chike OkonkwoTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Wrongful eviction
Facility abandoned resident
INVESTIGATION FINDINGS:
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***THIS REPORT HAS BEEN AMENDED TO CORRECT TYPOGRAPHICAL ERRORS***
At approximately 9:18 AM on 01/19/22, Licensing Program Analyst (LPA) Nicholas Reed arrived for an unannounced complaint investigation for Complaint Control Number 31-AS-20220112171708. LPA met with staff and later Licensee and disclosed the reason for the visit.
LPA conducted a physical plant tour at approximately 9:40 AM. LPA obtained and reviewed facility documents at 10:04 AM. LPA interviewed staff at approximately 10:10 AM and approximately 1:00 PM.

Regarding the allegation “wrongful eviction”, it was alleged the facility wrongfully evicted Resident R1 without written notice. LPA interviewed staff and reviewed records on 01/19/2022 from 10:04 AM to approximately 1:00 PM. LPA discovered Licensee did not provide written notice to resident prior to eviction, and this posed a potential health and safety risk to the resident in care. Based on information obtained from records review and interviews, the above allegation is deemed substantiated.
Exit interview conducted, appeal rights discussed, and a copy of report issued.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022
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 3
Control Number 31-AS-20220112171708
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: BEWISE HOME
FACILITY NUMBER: 197609568
VISIT DATE: 01/19/2022
NARRATIVE
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Regarding the allegation “Facility abandoned resident”, it was alleged the facility left resident at the hospital on 01/12/2022 without supervision. LPA interviewed staff and reviewed records on 01/19/2022 from 10:04 AM to approximately 1:00PM. LPA discovered Licensee instructed staff to leave resident at hospital due to nonpayment which posed an immediate health and safety risk to the resident in care. Based on information obtained from records review and interviews, the above allegation is deemed substantiated.

Exit interview conducted, appeal rights discussed, and a copy of report issued.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20220112171708
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: BEWISE HOME
FACILITY NUMBER: 197609568
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/19/2022
Section Cited
CCR
87464(f)(1)
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87464 Basic Services
(f) Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).

This requirement is not met as evidenced by:
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Licensee returned resident to facility where staff provide care and supervision.
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Based on information obtained through records review and interviews, LPA determined Licensee abandoned resident at the hospital and did not provide care and supervision. This posed an immediate health and safety risk to the resident in care.
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Type B
02/18/2022
Section Cited
CCR
87224(a)(1)
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87224 Eviction Procedures (a) The licensee may evict a resident... Thirty (30) days written notice to the resident is required ... (1) Nonpayment of the rate for basic services within ten days of the due date.
This requirement is not met as evidenced by:
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Licensee will issue a 30 day eviction to resident and LPA.
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Based on information obtained through records review and interviews, LPA determined Licensee failed to provide written notice prior to eviction. This posed a potential health and safety risk to the resident 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: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3