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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609931
Report Date:
04/26/2021
Date Signed:
04/26/2021 04:27:50 PM
Unsubstantiated
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
04/22/2021
and conducted by Evaluator
Wendell Smith
PUBLIC
COMPLAINT CONTROL NUMBER:
31-AS-20210422161254
FACILITY NAME:
KAREN'S BOARD AND CARE, INC
FACILITY NUMBER:
197609931
ADMINISTRATOR:
ZINKOFSKY, CLARITA
FACILITY TYPE:
740
ADDRESS:
17231 TUBA STREET
TELEPHONE:
(818) 216-3271
CITY:
NORTHRIDGE
STATE:
CA
ZIP CODE:
91325
CAPACITY:
6
CENSUS:
4
DATE:
04/26/2021
UNANNOUNCED
TIME BEGAN:
08:30 AM
MET WITH:
Clarita Zinkofsky
TIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not wearing mask in the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted a subsequent complaint visit to investigate the allegation above. Due to the situation with Covid-19 this visit was conducted by telephone with administrator Clarita Zinkofsky.
LPA conducted the initial visit regarding this allegation on 4/23/21. It is alleged that in late December 2020 and January 2021 that staff did not wear mask while working in the facility. LPA previously conducted interviews with two residents who were able to understand what was being asked regarding the allegation. LPA also interviewed two staff that were working during the visit regarding the allegation. Based on the information obtained during interviews there is not enough information to state that staff were not wearing their mask while working in the facility. Therefore this allegation is deemed Unsubstantiated at this time.
Exit Interview conducted. Copy of report emailed for signature.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME
:
Cassandra Harris
LICENSING EVALUATOR NAME
:
Wendell Smith
LICENSING EVALUATOR SIGNATURE
:
DATE:
04/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099
(FAS) - (06/04)
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