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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610489
Report Date: 05/29/2024
Date Signed: 05/29/2024 02:00:07 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
05/21/2024 and conducted by Evaluator Leslie Ngo-Castaneda
COMPLAINT CONTROL NUMBER: 31-AS-20240521091912
FACILITY NAME:VELVET CARE 2FACILITY NUMBER:
197610489
ADMINISTRATOR:PAROYAN, NAIRAFACILITY TYPE:
740
ADDRESS:16909 CITRONIA STREETTELEPHONE:
(310) 480-2009
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 5DATE:
05/29/2024
UNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Cynthia Sherriel- StaffTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility staff abusing residents.
INVESTIGATION FINDINGS:
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On 5.29.2024 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at the facility to conduct an unannounced complaint visit regarding the above allegation. LPA was greeted by Cynthia Sherriel (S2) who is the designated staff of the facility. Entrance Interview conducted.

At 10:03 AM with the assistance of the staff, LPA conducted a physical plant tour to ensure the health and safety of the residents in care. A case management deficiency will be cited for the unauthorized alteration having a passageway from the garage to the facility. Record review, LPA received: admission agreement, ID and emergency information, appraisal, physicians report, CSMDR, and all other necessary documents.

Allegation: Facility staff abusing residents.

Continue to LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
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-20240521091912
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: VELVET CARE 2
FACILITY NUMBER: 197610489
VISIT DATE: 05/29/2024
NARRATIVE
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Regarding the allegation of “Facility staff abusing residents.” it was alleged staff #1 (S1) member abused Resident #1 (R1). At 10:30 AM LPA interviewed R1 it was alleged that S1 would handle changing them roughly, and profanity and abusive words would be yelled by S1.

LPA did not observe any bruising and R1 stated that no bruising has ever happened that would be caused by staff. At 10:45 AM-11:15 AM, LPA interviewed four (4) out of five (5) residents and stated that no abuse was seen or experienced at the facility. Residences are happy and content with the facility and were very appreciative of the facility staff. At 11:15 AM interview with S2 stated that R1 can be very difficult and verbally abusive towards all the staff and staff would just continue with the care needed to be given. At 11:25AM an interview with S1 revealed that R1 can be difficult but care is still given to all the residents. Staff would constantly do rounds to ensure all the residents health and safety. At 11:30 AM- 12NN LPA contacted two (2) family members of R1 and stated that R1 would always complain about a facility and is never content and would make up such allegation. A family member also visited R1 last week and no complaint was stated observed R1 to have no bruising or discomfort.

Interviews with other residents and staff revealed no information about staff verbally abusing residents. Based on interviews, facility staff did not verbally abuse R1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety hazards were observed during this visit.

Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
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