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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 421703549
Report Date: 03/06/2023
Date Signed: 03/09/2023 12:47:55 PM

Substantiated


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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/28/2023 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20230228133212
FACILITY NAME:DEVEREUX FOUNDATION - WEISMAN CENTER (RCFE)FACILITY NUMBER:
421703549
ADMINISTRATOR:ENEDILIA AVILAFACILITY TYPE:
740
ADDRESS:6960 DEVEREUX WAYTELEPHONE:
(805) 879-0338
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:15CENSUS: 15DATE:
03/06/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jennifer Farley, Program DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not provide access to a resident's records.
INVESTIGATION FINDINGS:
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On 3/6/2023 at 1:00 pm, Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced initial visit for this complaint. LPA met with Jennifer Farley, Program Director and Enedelia Avila, Program Administrator,, and explained the purpose of the visit.
On the allegation: Staff did not provide access to a resident's records. To investigate the complaint, LPA reviewed documents including a Subpoena for records dated 1/26/2023 for former Resident 1 (R1)’s entire resident file, and an attached authorization stating that R1’s responsible party authorized the attorney to handle the claim, signed 1/25/2023 by R1’s responsible party. The subpoena states “Evidence Code 1158 of the California Standard Code states the following: Failure to make such records available, during business hours, within five (5) days after the presentation of the written authorization, may subject the person or entity having custody or control of the records to liability for all reasonable expenses, including attorney's fees, incurred in any proceeding to enforce this section. NOTE: ENCLOSED DECLARATION MUST BE SIGNED AND ATTACHED TO THE RECORDS BEFORE ALLOWING RECORDS TO BE COPIED BY OR SENT TO [copy company].” Please continue to 9099-C, Pg 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023
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-20230228133212
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: DEVEREUX FOUNDATION - WEISMAN CENTER (RCFE)
FACILITY NUMBER: 421703549
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2023
Section Cited
CCR
87506(c)(1)
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87506(c)(1) Resident Records
The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative.

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Program Director agreed to provide R1’s responsible party’s attorney all of R1’s records by 3/6/2023, and copy LPA on the email to confirm the documents were provided to R1’s responsible party and Attorney on record.
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This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the above cited section when they failed to provide R1’s responsible party’s attorney all of R1’s records as requested in a subpoena, which posed a potential personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3