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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610161
Report Date: 02/04/2025
Date Signed: 02/04/2025 02:45:47 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.RO, 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
01/31/2025 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20250131082825
FACILITY NAME:BETD SAN FERNANDO CARE LLCFACILITY NUMBER:
197610161
ADMINISTRATOR:TIKU, ELIZABETH A.FACILITY TYPE:
740
ADDRESS:628 NORTH LAZARD STREETTELEPHONE:
(818) 493-8351
CITY:SAN FERNANDOSTATE: CAZIP CODE:
91340
CAPACITY:6CENSUS: 4DATE:
02/04/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Elizabeth TikuTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained an unexplained injury due to staff neglect.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 02/04/2025 at 09:45 am Licensing Program Analysts (LPAs) Lorena Casillas and Nadia Shahbazian conducted an unannounced complaint visit to investigate the above stated allegation. LPAs were greeted by staff member who granted access and called Administrator, Elizabeth Tiku. LPA Casillas spoke to Administrator and was told that Administrator would arrive shortly. Entrance interview conducted.

At 10:30 am LPAs conducted a physical plant tour. During the investigation, interviews and record reviews were conducted from 10:30 am to 2:00 pm. LPA Casillas requested copies of resident roster, LIC 500, Liability Insurance and Administrator Certificate. LPAs requested copies of pertinent information relevant to the investigation including but not limited to admission agreements, resident medical records, and any information pertaining to residents in care.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
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-20250131082825
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BETD SAN FERNANDO CARE LLC
FACILITY NUMBER: 197610161
VISIT DATE: 02/04/2025
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
Allegation: Resident sustained an unexplained injury due to staff neglect.

It is alleged that a resident sustained an unexplained injury due to staff neglect. Regarding this allegation it is reported that Resident #1 (R1) sustained an injury of unknown origin on 1/29/2025. It was stated that when Staff #1 (S1) left R1 for the night on 1/28/25 when S1’s shift ended, R1 had no visible injuries, however when S1 returned the next day, R1 had an injury to R1’s right arm. This injury of unknown origin caused R1 to be taken to the emergency room for further evaluation. LPA Casillas interviewed Administrator and it was revealed that Administrator checked on R1 the morning of 1/29/25 at 09:30am and performed grooming needs for R1, this included a body check and there were no visible injuries. Later at approximately 10:40 am Administrator states that S2 made them aware that there was bruising and swelling to R1’s right arm. This was cause for alarm and Administrator called 911 that resulted in R1 visiting the emergency room. Administrator states that R1 did not cry out or alert any of the staff that R1 was hurt or in distress and that they are not sure as to how R1’s arm was injured as R1 is nonverbal and could not communicate with staff. Furthermore, Administrator stated that as soon as they were made aware of the bruising, they took immediate action and called 911. LPA Casillas was able to conduct a phone interview with S1 and S1 revealed that when their shift was over on 1/28/25, R1 seemed in good condition and that they are not sure how R1 was injured as they did not witness any falls or injuries, nor have other staff members mentioned any incidents. LPA Casillas’ interview with Staff #2 (S2) revealed that they also do not know how R1 was injured as they have not witnessed any falls or injuries and S2 is not sure as to a possible cause of injury. LPA Casillas attempted to interview R1 however, as previously stated, R1 is non-verbal and LPA was not able to obtain information. LPA Casillas along with S2's assistance was able to observe R1’s arms from fingertips to shoulders and there were no other visible injuries aside from R1's right arm in a cast, there was no visible bruising or swelling. Interviews with Resident #2 and #3 (R2, R3) also revealed that they have not witnessed any injuries, falls or any staff hurting any residents. During LPAs record review of R1’s medical records there was no indication on how this injury was obtained, furthermore there is no record that this was an injury due to staff neglect, records only indicate that there was a fracture due to an injury of unknown origin and that 911 services were called to assist R1. Therefore, based on observations, interviews and record reviews, this allegation of "Resident sustained an unexplained injury due to staff neglect." is deemed unsubstantiated.

No citation issued. Exit interview conducted. Copy of report given to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2