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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801589
Report Date: 01/13/2025
Date Signed: 01/13/2025 06:05:10 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 Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20240110165920
FACILITY NAME:FAMILYCARE COTTAGE IIFACILITY NUMBER:
565801589
ADMINISTRATOR:DEBRA BRYANTFACILITY TYPE:
740
ADDRESS:389 RAMBLE RIDGE DR.TELEPHONE:
(805) 492-1200
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 5DATE:
01/13/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Marisol Flamenco-Staff TIME COMPLETED:
06:05 PM
ALLEGATION(S):
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Medication is not being administered as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced subsequent complaint visit. The LPA met with staff and explained the reason for the visit. Administrator Debra Bryant approxiamtely arrived at 4:00 p.m. The facility was under a red flag warning during today's visit.

On 01/10/2024, the Department received a complaint regarding the following allegation, Medication is not being administered as prescribed. On 01/17/2024, LPA Campos, interviewed staff at 12:33 p.m. and 12:38 p.m. and the administrator at 12:50 p.m. reviewed and collected pertinent documents at 2:00 p.m. The LPA determined further investigation was required prior to issuing findings. During today's visit on 01/13/2025, LPA Cortez conducted a medication audit at 11:40 a.m., interviewed the administrator, three (3) staff and one (1) resident starting at 1:00 p.m., conducted a brief tour of the home at 2:35 p.m., and conducted a file review at 4:00 p.m.
Report will continue on LIC9099-C, 2nd page.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
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 29-AS-20240110165920
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: FAMILYCARE COTTAGE II
FACILITY NUMBER: 565801589
VISIT DATE: 01/13/2025
NARRATIVE
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On the allegation that the “Medication is not being administered as prescribed”, it is the concern of the reporting party (RP) that a former staff member (S1) had been stealing Norco medication from residents and administering Tylenol instead. It was further reported that after Resident 1's (R1's) passing on 12/30/2023, it was discovered their Norco medication was missing, and S1 was suspected of taking it. To investigate the allegation, LPA Campos and Cortez interviewed staff and LPA Cortez conducted a medication audit for all five (5) residents and a file review for R1. Staff interviews revealed that they have not witness or suspected any staff stealing or mishandling residents medications, do not have any concerns of residents not being administered their prescribed medications, and that S1 no longer works at this facility. Resident interviewed did not voice any concerns. At 11:40 a,m, the LPA conducted a medication audit and reviewed the Centrally Stored Medication and Destruction Record (CSMDR), along with the medications in their bubble packs/bottles for the month of January of this year. Medication audit revealed each resident was administered their medications as prescribed from 1/1/2024 to present, at this time. File Review revealed that R1's Norco medication was discontinued on 12/11/2023. Based on interviews conducted, medication audit, and file review although the allegation may have happened or is valid, the department does not have sufficient evidence to determine that Medication is not being administered as prescribed. Therefore, the above allegation is deemed UNSUBSTANTIATED at this time

Exit interview conducted and report issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2