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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609931
Report Date: 10/19/2022
Date Signed: 10/19/2022 02:35:54 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
03/09/2021 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20210309154452
FACILITY NAME:KAREN'S BOARD AND CARE, INCFACILITY NUMBER:
197609931
ADMINISTRATOR:ZINKOFSKY, CLARITAFACILITY TYPE:
740
ADDRESS:17231 TUBA STREETTELEPHONE:
(818) 216-3271
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:6CENSUS: 5DATE:
10/19/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gloria Bisda, Augusto LumanlanTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff forced resident to eat.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPA met with staff, Gloria Bisda and Augusto Lumanlan and advised them of the purpose of the visit. LPA spoke with the administrator, Clarita Zinkofsky over the telephone. Today's investigation consisted of interviews with residents and staff, a physical plaint inspection and record review. At approximately 9:30am-10:30am, LPA conducted a physical plant inspection. Between 10:30am-12:30pm, interviews made with staff, the administrator and residents. At approximately 12:30pm-1:30pm, LPA conducted a record review of facility records.
During the course of the investigation, LPA interviewed the administrator and two (2) of two (2) staff. They all denied the allegation. LPA interviewed five (5) of (5) residents, and all five could not confirm that the allegation had occurred. There were no witnesses identified to the allegation, and Resident 1 (R1) has since passed. Based on the information obtained, there was insufficient evidence to corroborate the allegation of resident being forced to eat. Therefore, the allegation is deemed Unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
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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