405801701-10-29-2024-29-AS-KBUY-DAJRC6-20241030125346

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405801701
Report Date: 10/29/2024
Date Signed: 10/29/2024 01:18:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/14/2023 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20230814164102

FACILITY NAME:	C.A.L.L.-CARMELITA HOUSE		FACILITY NUMBER:	405801701
ADMINISTRATOR:	KYLAN REYNOSO		FACILITY TYPE:	740
ADDRESS:	2660 FERROCARRIL		TELEPHONE:	(805) 466-8502
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	6	CENSUS: 6	DATE:	10/29/2024
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Joni Chapman		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff did not respond to resident’s requests for assistance.
Staff are handling resident(s) in a rough manner while in care.
Facility did not report alleged abuse.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Joni Chapman and explained the purpose of the visit. During the initial visit on 8/18/2023 from 10:10am to 12:05pm, LPA Chavez toured the facility, interviewed staff, and obtained relevant documents. On 9/7/2023 at 9:02am, LPA interviewed Executive Director (ED) regarding video footage in the facility. ED stated they reviewed footage for dates 8/3/2023 through 8/9/2023, and the system did not go back further.

On the allegation: Staff did not respond to resident’s requests for assistance. It was alleged on 7/5/2023, Client 2 (C2) was in bed and asked S1 for water, but S1 did not provide C2 with water and laughed. It was alleged S1 regularly denies things clients ask for and ignore them when they request assistance.
Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

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 3

Control Number 29-AS-20230814164102

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: C.A.L.L.-CARMELITA HOUSE	FACILITY NUMBER: 405801701
	VISIT DATE: 10/29/2024

NARRATIVE

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Administrator stated they had not heard about a staff refusing water to a resident, and stated staff never refuse water. Administrator noted one resident always like to drink water, and they place bottled water in resident’s rooms. Staff interviewed stated they had not observed staff refuse water to any clients, and stated “we give clients what they ask for.” Clients in the home were interviewed, and were unable to provide feedback on their care. LPA interviewed a credible witness, who stated at the time of this complaint they had not heard of staff not providing clients water. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

On the allegation: Staff are handling resident(s) in a rough manner while in care. It was alleged on 7/30/2023, S1 bragged about dragging C1 out of another client’s room by their feet, from a distance from the bed to the doorway. Allegedly, S1 stated no matter what they do, the facility will not fire them. A credible witness also spoke with staff, who indicated C1 sometimes needs assistance leaving other client’s rooms, but is compliant when escorted out by staff. All staff denied rough handling to the credible witness. ED stated they reviewed video footage in the facility for dates 8/3/2023 through 8/9/2023, and did not observe anything concerning and no indications on the video footage C1 was dragged. However, ED observed footage that another client (C3) tripped on 8/30/2023, put their hand out on a door jamb, and dislocated their finger, even though staff were right behind C3. Staff interviewed stated they had never witnessed staff pulling a client or handling a client in a rough manner. Staff stated if that were to happen, they would report it to a lead or supervisor, and create documentation or an incident report. Clients in the home were interviewed, and were unable to provide feedback on their care. LPA interviewed a credible witness, who stated at the time of this complaint they had not heard of staff handling residents in a rough manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 29-AS-20230814164102

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: C.A.L.L.-CARMELITA HOUSE	FACILITY NUMBER: 405801701
	VISIT DATE: 10/29/2024

NARRATIVE

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On the allegation: Facility did not report alleged abuse. It was alleged the behaviors of S1 were reported to facility Human Resources (HR) and management, but the alleged abuse was not reported. Administrator stated they were not aware of any abuse in the facility, and do not believe any rough handling occurred. Administrator stated staff would report the abuse. Staff interviewed stated they had never witnessed staff pulling a client or handling a client in a rough manner. Staff stated if that were to happen, they would report it to a lead or supervisor, and create documentation or an incident report. Administrator stated S2 was not caring about the quality of care and they were let go after another staff reported the performance issues. On this complaint, there was insufficient evidence to substantiate that abuse occurred, and therefore insufficient evidence to prove it was not reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

Exit interview, report given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

LIC9099 (FAS) - (06/04)

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