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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191592733
Report Date: 09/11/2024
Date Signed: 09/11/2024 12:21:57 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
09/03/2024 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240903113122
FACILITY NAME:L.A HOMEFACILITY NUMBER:
191592733
ADMINISTRATOR:SALVADOR, ERLINDAFACILITY TYPE:
735
ADDRESS:13881 SARANACTELEPHONE:
(562) 941-2830
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY:6CENSUS: 4DATE:
09/11/2024
UNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Erlinda Salvador, AdministratorTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Licensee did not ensure there is adequate staffing and supervision.
Facility staff does not provide a safe environment for clients.
Facility does not provide a comfortable temperature to clients in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint investigation visit regarding the above allegations. LPA explained the purpose of the visit to DSP Kaylon De La Rosa. Administrator Erlinda Salvador arrived shortly after.

The investigation consisted of: A tour of the interior and exterior physical plant was conducted, with special focus on resident rooms, wall A/C units, and doors. Resident Identification and Emergency Information, Face Sheets, and Day Program Information was reviewed and copies were obtained. The Regional Center Corrective Action Plan (8/29/24), LIC 500 Personnel Report, and Register of Facility Clients were also obtained. Staff (S1-S4) and clients (C1- C2) were interviewed. Client (C3) has limited comprehension and client (C4) was not available for an interview; therefore were not interviewed.

*Narrative continues next page.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
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 5
Control Number 28-AS-20240903113122
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: L.A HOME
FACILITY NUMBER: 191592733
VISIT DATE: 09/11/2024
NARRATIVE
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Allegation: Licensee did not ensure there is adequate staffing and supervision. It was reported that the facility did not have a current weekly staff schedule and discrepancies in recorded hours were observed. Based on record review, the findings indicate that on August 20, 2024 review of staff schedules revealed staff hours worked were not accurate i.e., several hours of staff coverage were unaccounted for. The staff schedule did not list any scheduled overnight staff. Licensee assumed that the live-in staff met staffing requirements, even though their shift ended at 10 PM. The facility has 2 live-in staff, but one of the staff only works Sundays. Prior to August 30, 2024, there were only 6 staff employed. On August 30, 2024, Licensee hired 2 additional staff to work the NOC shift. All four staff confirmed that there was not any NOC shift staff employed prior to 8/30/24, but stated that there is always a staff present in the home. Two (2) residents were interviewed. The residents were unable to provide details about staffing. The facility is a level 3 home. The staff to individual ratio is 1 to 4, and during outings it should be 2 to 4 for additional support. The Regional Center issued a Corrective Action Plan on August 29, 2024. There is sufficient evidence to corroborate the allegation because the 2 live-in staff (S3 & S4) were not being compensated for overnight shifts, were not awake at night, potentially resulting in inadequate supervision.

Allegation: Facility staff does not provide a safe environment for clients. It is alleged the facility is posing a risk and violating client rights by having a lockable doorknob on the entrance to the kitchen, and client (C1's) bed obstructed the exit door in the room that leads into the backyard. All staff confirmed that client (C1's) bed obstructed the exit room door, but stated that the bed and chair have been rearranged in the room and are no longer obstructing the exit door. Client (C1) confirmed their bed obstructed the room exit door. During today's visit, the bed was not observed to be obstructing the room exit door. Additionally, staff stated that the kitchen door had a lockable handle in order to prevent client (C2) from exiting at night to smoke, and also to prevent client (C3) from going to the refrigerator to get milk. Client (C3) has a dairy allergy. According to HCBS rule, there should not be a lockable door knob to enter the kitchen. During today's visit, the kitchen door knob was observed to no longer have a lock. The Regional Center issued a Corrective Action Plan on August 29, 2024. There is sufficient evidence to corroborate the allegation.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20240903113122
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: L.A HOME
FACILITY NUMBER: 191592733
VISIT DATE: 09/11/2024
NARRATIVE
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Allegation: Facility does not provide a comfortable temperature to clients in care. It was reported that on August 20, 2024, a visitor observed the facility temperature to be uncomfortably hot at 85 DF. Additionally, the visitor observed live-in staff wearing inappropriate attire and sandals. The facility has a large temperature gauge in the living room area. All staff interviewed confirmed that on 8/20/2024, the air conditioning was turned off when the visitor arrived at approximately 4:30 PM. Staff stated that the air conditioning was on at 3 PM, but stated that some residents turn the air conditioning units off. On that day, staff do not know whom turned the air conditioning off in the living room. Staff stated that although it is Summer, sometimes the air conditioning is not turned on if it is not needed. According to staff, the rule is if the clients are not in their room their air conditioning wall unit is turned off. Two clients were interviewed. They stated the air conditioning works, but it gets hot. The facility does not have central heating or air conditioning, only wall units. Two fans were observed in the facility, which are often used when the A/C is not turned on. LPA tested all wall air conditioning units during the visit, and found them to be operable. The room temperature measured 72 DF. The Regional Center issued a Corrective Action Plan on August 29, 2024. There is sufficient evidence to corroborate the allegation.

Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are cited on LIC 9099D.

An exit interview was conducted and a copy of this report and appeal rights was provided to Licensee/Administrator Erlinda Salvador.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20240903113122
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: L.A HOME
FACILITY NUMBER: 191592733
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2024
Section Cited
CCR
85065(b)
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Personnel Requirements. The licensee shall employ staff as necessary to ensure provision of care and supervision to meet client needs.

This requirement was not met evidenced by:
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Administrator agreed to submit:
1. Written Plan of Correction
2. Proof of staff in-service training that includes staff signatures, name of training topic, and trainer name.

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Based on record review and interviews conducted the findings revealed that prior to 8-30-24, Licensee did not employ any NOC shift staff because it was assummed live-in staff met the supervision requirement. However, live-in staff end their shift at 10 PM. This posed a potential health and safety risk to clients in care.
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"I have 7 staff. The Regional Center does not want to accept that the live-in staff are in charge of NOC shift. They do not consider the live-in as NOC shift staff."
Type B
09/18/2024
Section Cited
CCR
80072(a)(7)
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Personal Rights. Each client has the right not to be locked in any room, building, or facility premises by day or night.

This requirement was not met as evidenced by:
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Administrator agreed to ensure staff do not lock any doors that lead to emergency exits, such as the hallway kitchen door. Submit proof of staff training.

* The lock on the door was removed.
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Based on information obtained and interviews, the kitchen door in the hallways had a lock to keep client out, which posed a potential health and safety risk to persons 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.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20240903113122
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: L.A HOME
FACILITY NUMBER: 191592733
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2024
Section Cited
CCR
80088(a)(1)
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Furniture, Fixtures, Equipment, and Supplies. A comfortable temperature for clients shall be maintained at all areas. The licensee shall maintain the temperature in rooms that clients occupy between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 degrees C).
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Administrator agreed to provide staff in-service training and submit proof to CCL.

*During today's visit, the temperature was comfortable throughout the facility, and all air conditioning units were tested and are operable.
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This requirement was not met evidenced by:
On August 20, 2024, a visitor observed the temperature in the facility to be 85 DF during a heat wave, and none of the wall air conditioning units were turned on. This posed a potential health and safety risks to persons 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.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5