191600825-11-9-2020-11-AS-MCAA-BXU2RK-20210201163741

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600825
Report Date: 11/09/2020
Date Signed: 11/09/2020 03:05:27 PM

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 DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/29/2020 and conducted by Evaluator Jade Jordan

COMPLAINT CONTROL NUMBER: 11-AS-20200529101106

FACILITY NAME:	DIANA'S HOME		FACILITY NUMBER:	191600825
ADMINISTRATOR:	RENTERIA, DIANA LEE		FACILITY TYPE:	735
ADDRESS:	827 GIAN DRIVE		TELEPHONE:	(213) 533-5128
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90502
CAPACITY:	6	CENSUS:	DATE:	11/09/2020
		UNANNOUNCED	TIME BEGAN:	02:47 PM
MET WITH:	Eve Hensey (Tighe)		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff did not dispense medication as prescribed
Facility staff did not serve food in a timely manner
Facility is not kept free of insects

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jade Jordan conducted a continuation of an unannounced 10-day complaint Tele-visit, to deliver findings. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Eve Hensey (Tighe).
LPA explained the purpose of today’s call is to complete and deliver findings for the above-mentioned allegations. “
The investigation consisted of the following: virtual tour via FaceTime of the inside of the facility, Interview with the Administrator, Licensee, Staff #1-2 and Residents #1-4. Review of Residents records, Medication Records. LPA Jordan obtained copies of all documents reviewed.

(REPORT CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020

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 11-AS-20200529101106

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: DIANA'S HOME	FACILITY NUMBER: 191600825
	VISIT DATE: 11/09/2020

NARRATIVE

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The investigation revealed the following:

Regarding allegation – Facility staff did not dispense medication as prescribed

The Administrator stated that due to the Corona virus Clients are no longer attending day program. Due to this, the clients are no longer on such an early wake up schedule. When day program was in session clients were woken up to get ready at around 7:00am to get ready eat breakfast, take morning medications and be ready for transportation to Day program. All 4 Clients attended day program. One had public transportation that would pick client up from the home at 8:30am, and the other clients were transported by staff by 8;40am to another day program all together.

Clients go to bed later, and in turn wake up later. Clients are still served breakfast and given Am medication. Breakfast is given around 10am. 3 of the 4 clients take daily medication. Admin states that all medication prescribed must be taken in the morning. No specific time frame was issued by the doctor. .

Based on LPA Jordan’s observations, and virtual tour of the facility, Medication record review and the interviews that were conducted Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

Regarding allegation – Facility staff did not serve food in a timely manner.

Administrator stated that since the girls are no longer on a day program schedule, they are not requiring the girls to Get up as early or go to bed as earlier as they had prior. Breakfast times will fluctuate, but generally not served later than 10 am. Breakfast is cooked by Administrator, Eve Hensey, or Licensee Diana.

Based on interviews with Residents#1-4 (R1-R4), Residents generally stated that they receive breakfast, lunch and dinner, and have no concerns about the times received.

Based on LPA Jordan’s observations, and virtual tour of the facility, record review and the interviews that were conducted. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20200529101106

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: DIANA'S HOME	FACILITY NUMBER: 191600825
	VISIT DATE: 11/09/2020

NARRATIVE

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Regarding the allegation- Facility is not kept free of insects

Facility Administrator and Licensee said that they have not had any type of insect infestation. Licensee stated that during certain seasons they get the occasional ant trail that comes in. Administrator stated that they keep a very clean house, especially due to corona virus, and that they daily use bleach to clean counter tops, and floors, due to the health condition of R3. LPA asked if they had any bugs, such as roaches within the home recently, Administrator and Licensee said no. Interviews conducted with Client 1 stated that they had seen “a black bug” in the home. Other verbal residents 3-4 denied seeing bugs.

Reporting Party, sent a picture (not dated) to LPA Jordan, of 1 un-identified small black bug, and stated, that there were many bugs witnessed on occasion. Based on LPA’s observation (no insects were seen), and interviews that were conducted with residents, and staff. The LPA finds that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted, and copy of this report was furnished to Administrator. No citations were issued during this visit.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020

LIC9099 (FAS) - (06/04)

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