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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801505
Report Date: 01/18/2024
Date Signed: 01/18/2024 05:05:49 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
01/10/2024 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20240110170429
FACILITY NAME:FAMILYCARE COTTAGE ONEFACILITY NUMBER:
565801505
ADMINISTRATOR:CHRISSY CORTEZFACILITY TYPE:
740
ADDRESS:820 CALLE CEDROTELEPHONE:
(805) 492-1200
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 6DATE:
01/18/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Debra BryantTIME COMPLETED:
12:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Medication is not being administered as prescribed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Teresa Camara conducted an initial complaint investigation visit. LPA met with licensee/administrator Debra Bryant and explained the reason for the visit.

LPA interviewed the licensee at 9:10 a.m. LPA interviewed staff 1 (S1) at 10:10 a.m. while also reviewing the medications for all residents. LPA interviewed staff 2 (S2) at 10:52 a.m.

There was a suspicion of former staff mishandling medication for residents in one of the other homes owned by the licensee. However, all medications at this facility appear to be given as prescribed. The staff LPA interviewed had not witnessed or suspected any medication mishandling at this facility.

Based on the medication review and interviews, the allegation medication is not being administered as prescribed is deemed UNSUBSTANTIATED at this time. No defiiciencies cited. Exit interview conducted and report issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
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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