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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191593149
Report Date: 04/27/2023
Date Signed: 04/27/2023 05:59:58 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
04/21/2023 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230421160247
FACILITY NAME:HARVEST HOUSEFACILITY NUMBER:
191593149
ADMINISTRATOR:LIESS, CAROLFACILITY TYPE:
735
ADDRESS:14029 HARVEST AVENUETELEPHONE:
(562) 484-0320
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:8CENSUS: 5DATE:
04/27/2023
UNANNOUNCEDTIME BEGAN:
01:34 PM
MET WITH:Rosanna Reyes, House ManagerTIME COMPLETED:
06:06 PM
ALLEGATION(S):
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Staff are not ensuring that resident's grooming needs are being met.
Staff are over medicating resident in care.
Staff do not ensure that resident has toiletries as needed.
Staff do not ensure that resident's clothing needs are being met
INVESTIGATION FINDINGS:
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Licensed Program Analyst (LPA) Alberto Lopez made unannounced visit to investigate the above allegations. LPA met with Rosanna Reyes, House Manager and discussed the purpose the visit.


The investigation consisted of the following: Interviews were conducted with Rosanna Reyes, House Manager, Administrator Carol Liess (S1-S2) and 4 Clients (C1-C4) LPA reviewed Administration Records (MAR) and medications for 5 clients. LPA reviewed and obtained staff and client rosters. Admission Agreement, Appraisal and Needs services plan, Physician's Report for Community Care Facilities, Identification, and emergency information, record of Client’s cash resources for April 2023, Functional capability assessment and preplacement appraisal information for all 4 clients currently at the home. .

(Continued on 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
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 28-AS-20230421160247
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HARVEST HOUSE
FACILITY NUMBER: 191593149
VISIT DATE: 04/27/2023
NARRATIVE
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Allegation: Staff are not ensuring that resident's grooming needs are being met. It is alleged that C2 grooming is unkempt and not in good condition. LPA interviewed 4 clients presently at the home and all 4 clients stated that they take care of their own grooming, that facility is not responsible for their grooming but will help if clients ask. LPA interviewed 2 staff and was unsuccessful in reaching 3rd staff. 2 of 2 staff denied the allegation and stated that clients take care of their own grooming but will get assistance from staff if they need it. Staff stated they will encourage clients to take care of their grooming if they see it needs to be done. LPA observed the grooming of the 4 clients and all 4 clients grooming was in clean and good condition.

Allegation: Staff are over medicating resident in care. It is alleged that facility is over-medicating C2 to keep C2 sedated. LP interviewed 4 clients and all 4 clients did not collaborate the allegations. 2 of 2 staff denied the allegations. 4 of 4 clients stated they are aware of their medications, and all receive them according to doctor’s orders. LPA reviewed the medications and MAR for all 5 clients including one in hospital, and it has been dispensed according to doctor’s orders and no discrepancies were discovered. Record keeping was accurate and up to date. C2 was clear and oriented during the visit and C2 stated C2 is satisfied with facility dispensing C2 medication. Staff stated that Podiatrist visits every 2 months, Psychiatrist visits once per month, MD visits once per month. Social worker visits 2 times per week. RN visits 4-5 times per month. Therapy is provided upon referral from MD or request from client.

Allegation: Staff do not ensure that resident has toiletries as needed. It is alleged that C2 does not have any basic toiletries. During this investigation, LPA interviewed 2 staff and 2 of 2 staff denied the allegations. LPA interviewed 4 clients and all 4 could not collaborate the allegations. All 4 clients stated they have enough toiletries and showed the toiletries to LPA. LPA documented that number of toiletries in the facility for each clients use, and it is of sufficient supply. All 4 clients stated the facility provides enough toiletries, but they can also purchase their own if they desire a specific brand.

Allegation: Staff do not ensure that resident's clothing needs are being met. It is alleged that C2 does not have enough clothing and is wearing the same clothing for over 4 months. During this investigation, LPA toured the home and discovered that all clients have their own room at the time. LPA interviewed 2 staff and 2 of 2 staff denied the allegations. LPA interviewed 4 clients and 4 of 4 clients could not collaborate the allegations. All 4 clients stated they have enough clothing and if they want more, they can go buy more. S1 stated that facility staff takes them shopping every week for clothing or personal items. LPA toured the clients’ rooms and all 4 had plenty of clothing in their rooms, including shoes and undergarments. C2 stated that C2 undergarments are appropriate size for C2. C2 stated that C2 gets C2 money every month to spend as C2 wishes, including buying clothing.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2