191591883-3-9-2023-28-AS-RORN-CPWPQH-20230314113110

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191591883
Report Date: 03/09/2023
Date Signed: 03/09/2023 04:16:25 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/03/2023 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230303141756

FACILITY NAME:	TORY CARE HOME		FACILITY NUMBER:	191591883
ADMINISTRATOR:	DANILO RAMOS		FACILITY TYPE:	740
ADDRESS:	2721 TORY ST.		TELEPHONE:	(626) 965-4899
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91792
CAPACITY:	5	CENSUS: 3	DATE:	03/09/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Danilo Ramos		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Facility is not kept free of insects.
Staff do not handle resident's food in a safe manner.
Facility is not kept clean.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial complaint visit in reference to the above allegations. LPA explained the purpose of the visit to Licensee/Administrator Danilo Ramos and staff Estrella Ramos.

The investigation consisted of the following: A tour of the interior and exterior physical plant was conducted. Staff (S1- S3) and resident (R1) were interviewed. Residents (R2 & R3) have severe intellectual disability and/or are non-verbal and were not interviewed.

See LIC 9099C for report continuation.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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 28-AS-20230303141756

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: TORY CARE HOME	FACILITY NUMBER: 191591883
	VISIT DATE: 03/09/2023

NARRATIVE

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Allegation: Facility is not kept free of insects. It is alleged that on March 2, 2023 a visitor observed spider webs and spider web eggs were found in a kitchen cabinet. Insects and insect droppings were found in kitchen drawers as well. It is also stated that staff was dismissive and had an excuse about the issue. Three (3) pictures were obtained depicting proof of insects in drawer and cabinets. All staff interviewed acknowledged that spider webs/eggs and insect droppings were found on the aforementioned date. According to staff, the drawers and cabinets were deep cleaned after the issue was brought to their attention. One (1) resident was interviewed. The resident did not report knowledge of insects in the facility. During today's visit, the cabinets and drawers were observed to be clean and free of insects and/or insect droppings. Staff stated they deep cleaned the kitchen cabinets, drawers, and refrigerator last week.

Allegation: Staff do not handle resident's food in a safe manner. Based on information obtained, facility staff do not store food in refrigerator and are disregarding health and safety of residents because multiple issues were observed on 3/2/2023. For instance, spoiled cheese with expiration date of January 2019 was observed in the refrigerator, as well as spoiled fresh produce in the refrigerator. Additionally, a small ziploc candy bag with snacks in it appeared to have mold. Unsafe food handling practices were observed. Multiple food containers were observed on the stove top and counter areas, which contained sardines, orange juices, and beans. According to report, staff stated the food items not stored properly belonged to staff. A total of eight (8) pictures of expired food and food not stored properly were obtained. According to information gathered, staff threw away expired food during the 3/2/2023 visitor's visit. Staff interviews revealed that staff does keep food on top of the stove for extended periods of time, and had not cleaned the inside kitchen refrigerator in a long time. During today's visit, food containers were observed on the stove top. According to staff, the food belongs to staff and is kept that way due to cultural practices. The food containers were placed in the staff refrigerators during today's visit. Resident (R1) did not have food complains or issues with food safety.

See next page for report continuation.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 28-AS-20230303141756

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: TORY CARE HOME	FACILITY NUMBER: 191591883
	VISIT DATE: 03/09/2023

NARRATIVE

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Allegation: Facility is not kept clean. It is alleged that the facility is not kept clean and staff are dismissive about cleanliness. Dishware and rags were observed dirty on top of the counter and in drawers. Bathroom tiles, sinks, and floors need to be cleaned regularly. On March 2, 2023, dirty towels were observed on the floor next to the toilet. According to staff interviews, the facility floors and bathrooms are cleaned once a week, and light cleaning is performed daily, with the exception of resident (R1's) room and bathroom. Staff stated that R1 gets mad and antagonizes staff when staff attempt to clean it's room and bathroom. The resident likes to clean the bathroom on it's own. Staff acknowledged the facility was not cleaned during the visitor's visit. Resident (R1) stated the facility is kept clean, and acknowledged it does not allow staff to clean it's room. During today's visit, the facility floors were clean. However, the bathroom tile, sink, and floors were not clean. The exterior physical plant did not have discarded debris.

Based on observation, photo evidence, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22. See LIC 9099D.

Exit interview was conducted with Administrator Danilo Ramos. A copy of the report and appeal rights were issued.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 28-AS-20230303141756

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: TORY CARE HOME	FACILITY NUMBER: 191591883
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/09/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/16/2023 Section Cited CCR 87555(b)(27)	1 2 3 4 5 6 7	General Food Service Requirements. The following food service requirements shall apply: All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not met evidenced by:	1 2 3 4 5 6 7	Administrator agreed to submit a written statement of how this deficiency has been corrected.
	8 9 10 11 12 13 14	Based on observation, pictures obtained, and interviews conducted, the kitchen drawers and cabinets were dirty and had spider webs/spider web eggs, and insect droppings; which pose a potential health and safety risk to persons in care.	8 9 10 11 12 13 14
Type B 03/16/2023 Section Cited CCR 87555(b)(15)	1 2 3 4 5 6 7	General Food Service Requirements. The following food service requirements shall apply: All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination. This requirement was not met evidenced by:	1 2 3 4 5 6 7	Administrator agreed to submit a written statement about proper food handling, storage practices the facility will follow.
	8 9 10 11 12 13 14	Based on observation, interviews conducted, and pictures obtained, the facility keep expired food items in refrigerators, and does not follow safe food storage guidelines; which pose a potential health and safety risk to persons in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 28-AS-20230303141756

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: TORY CARE HOME	FACILITY NUMBER: 191591883
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/09/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/16/2023 Section Cited CCR 87303(a)(1)	1 2 3 4 5 6 7	Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement was not met evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator agreed to submit a written statement of how the deficiency was corrected, facility protocols, and proof the dishwasher, and 2 outside refrigerators have been deep cleaned.
	8 9 10 11 12 13 14	Based on observation and pictures obtained the findings indicate that the facility kitchen refrigerators, floors, and bathrooms were not clean during a visitor's visit on 3/2/2023; which poses a potenial health and safety hazard to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC9099 (FAS) - (06/04)

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