567609938-3-25-2022-29-AS-DPEA-CCYTPF-20220329145416

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609938
Report Date: 03/25/2022
Date Signed: 03/25/2022 02:12:55 PM

Unsubstantiated

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
09/07/2021 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20210907104058

FACILITY NAME:	RESIDENTIAL FIRST CARE, LLC		FACILITY NUMBER:	567609938
ADMINISTRATOR:	MEDINA, LIDIA		FACILITY TYPE:	740
ADDRESS:	6109 VERA ST		TELEPHONE:	(818) 577-8231
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY:	6	CENSUS: 5	DATE:	03/25/2022
		UNANNOUNCED	TIME BEGAN:	12:14 PM
MET WITH:	Jackie Olivera		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not ensure that resident had access to their call button.
Staff did not respond to resident’s calls for help in a timely manner.
Staff did not obtain timely medical treatment for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced subsequent complaint visit to deliver final investigation finding regarding above allegations. During today’s visit LPA Chochian met with staff and later spoke with administrator on the phone. Reason for the visit explained.

Following is a summary of the investigation:

On 09/07/2021 the Department received a complaint with the above allegations. It was reported that resident #1 (R1) was not feeling well and tried to call for help and the call button was out of reach. Apparently, no staff responded until the morning. It was also reported that the same happened a couple weeks ago.
On 09/16/2021, LPA Chochian conducted the initial complaint visit. Physical plant tour was conducted with staff at 10:30am-11am; during the physical plant tour residents were observed and interviewed. LPA observed call button in resident rooms accessible to residents within reach. (continue to LIC9099c)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

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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Control Number 29-AS-20210907104058

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: RESIDENTIAL FIRST CARE, LLC	FACILITY NUMBER: 567609938
	VISIT DATE: 03/25/2022

NARRATIVE

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Residents able to communicate with LPA were interviewed privately. Two (2) out four (4) residents interviewed reported feeling safe in the facility, did not report any mistreatment by staff and reported receiving timely attention to all aspects of personal care and medical treatment when needed. On 12/16/2022, LPA made contact with other potential witness and it was reported that there are no issues or concerns with the personal care provided by staff or the administrator of the facility.

Based on the above, there is not enough evidence to support allegations. Therefore, allegations are deemed Unsubstantiated at this time.

Exit interview conducted. Copy of report emailed to Administrator

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

LIC9099 (FAS) - (06/04)

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