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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191640255
Report Date: 02/01/2022
Date Signed: 02/01/2022 05:30:58 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, 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
01/31/2022 and conducted by Evaluator Ulysses Coronel
COMPLAINT CONTROL NUMBER: 11-AS-20220131083928
FACILITY NAME:FRANK'S ADULT RESIDENTIAL HOMEFACILITY NUMBER:
191640255
ADMINISTRATOR:EDWARD GOODSONFACILITY TYPE:
735
ADDRESS:1911 W. 137TH STREETTELEPHONE:
(310) 632-1213
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY:16CENSUS: 13DATE:
02/01/2022
UNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Edward GoodsonTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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9
Unqualified administrator
Missing medication
Staff selling items to residents in care
Staff take residents meals
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ulysses Coronel and LPA Jeremiah Randle initiated a complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Edward Goodson, the facility administrator and the purpose of the visit was explained.

The investigation consisted of the following: During todays visit LPA’s and staff S1 conducted a tour of the facility, evaluated the food supply and medication supply. During todays visit LPA’s reviewed resident and facility records. During today’s visit LPA Coronel interviewed 6 out of 13 clients and 2 staff.

The investigation revealed the following: Regarding the allegation “Unqualified administrator” during todays visit licensee Edward Goodson identified himself as the administrator for the facility and identified S1 as a caregiver staff. Record reviews indicate that Edward Goodson is the administrator on record and that his Administrator Certificate is valid and current. Regarding the allegation “Unqualified administrator” Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
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 7
Control Number 11-AS-20220131083928
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: FRANK'S ADULT RESIDENTIAL HOME
FACILITY NUMBER: 191640255
VISIT DATE: 02/01/2022
NARRATIVE
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Regarding the allegation “Missing medication” During todays visit LPA Coronel reviewed clients C1, C2 and C3’s medication supply for the month of February 2022 by comparing the medications versus the medication list based from the Medication Administration Record provided by the pharmacy, LPA observed that all medications listed are present. Residents C1, C2 and C3 did not have issues regarding missing medications. Regarding the allegation “Missing medication” Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation “Staff selling items to residents in care” During todays visit LPA observed at least 6 packs of cigarettes and at least 12 cans of soda stored in one of the facilities refrigerators. The administrator stated that he provides around 30 dollars for staff to buy cigarettes and sodas and sell them to residents at cost. The administrator stated that “Due to the pandemic, I would rather the clients buy cigarettes here than have them risk getting exposed by buying them at the store.” Regarding the allegation “Staff selling items to residents in care” Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation: “Staff take residents meals” During todays visit 1 out of 2 staff denied taking the facility’s meals or food supply home for personal use. 1 out of 2 staff is unavailable for interview. 6 out of 6 clients interviewed denied witnessing staff bringing home the facility’s meals or food supply. Regarding the allegation: “Staff take residents meals” Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated

An exit interview was conducted, and a copy of this report was provided to administrator.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
01/31/2022 and conducted by Evaluator Ulysses Coronel
COMPLAINT CONTROL NUMBER: 11-AS-20220131083928

FACILITY NAME:FRANK'S ADULT RESIDENTIAL HOMEFACILITY NUMBER:
191640255
ADMINISTRATOR:EDWARD GOODSONFACILITY TYPE:
735
ADDRESS:1911 W. 137TH STREETTELEPHONE:
(310) 632-1213
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY:16CENSUS: 13DATE:
02/01/2022
UNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Edward GoodsonTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Old medications are not disposed of.
Facility does not have enough food.
Improper documentation
Facility is in disrepair
INVESTIGATION FINDINGS:
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2
3
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5
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7
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13
Licensing Program Analyst (LPA) Ulysses Coronel and LPA Jeremiah Randle initiated a complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Edward Goodson, the facility administrator and the purpose of the visit was explained.

The investigation consisted of the following: During todays visit LPA’s and staff S1 conducted a tour of the facility, evaluated the food supply and medication supply. During todays visit LPA’s reviewed resident and facility records. During today’s visit LPA Coronel interviewed 6 out of 13 clients and 2 staff.

The investigation revealed the following: Regarding the allegation:” Old medications are not disposed of” During todays visit LPA observed that C1 and C2’s medication form October, November and December are still being kept with the centrally stored medications for February 2022. The administrator stated that they were supposed to have been destroyed after their monthly cycle’s but was not able to provide an answer why they were not destroyed.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 11-AS-20220131083928
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: FRANK'S ADULT RESIDENTIAL HOME
FACILITY NUMBER: 191640255
VISIT DATE: 02/01/2022
NARRATIVE
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Regarding the allegation:” Old medications are not disposed of” Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegationis found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Regarding the allegation: “Facility does not have enough food.” During todays visit LPA’s Coronel and Randle did not observe a minimum of seven days supply of non-perishable food present at the facility. LPA’s observed at least 80 expired canned vegetables and at least 10 bottles of expired fruit juices included in the facility’s non-perishable food supply. Regarding the allegation: “Facility does not have enough food.” Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LI 9099D. .

Regarding the allegation: “Improper documentation” during todays visit LPA Coronel reviewed C1’s client record and observed documentation of a missing person’s report dated 07/01/2021 submitted to the Los Angeles Sheriff’s Department. The administrator stated that they were the one who made the report. LPA conducted record reviews and did not observe an incident report in C1’s client record. LPA conducted a review of CCL’s records and did not observe an incident report submitted by the administrator. Regarding the allegation: “Improper documentation” Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Regarding the allegation: “Facility is in disrepair” During todays visit LPA’s Coronel and Randle observed that the door of the refrigerator in the dining area, The linoleum floors in the upstairs bedrooms, the light switch in the upstairs bathroom, the paint on the ceiling by the stairs, the door knob by the men’s bedroom and the window in bedroom #3 are in disrepair. Regarding the allegation: “Facility is in disrepair” .” Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D. Title 22 regulations regarding Buildings and Grounds was cited within the last 12 months and a civil penalty is being assessed, please see LIC421FC.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 11-AS-20220131083928
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: FRANK'S ADULT RESIDENTIAL HOME
FACILITY NUMBER: 191640255
VISIT DATE: 02/01/2022
NARRATIVE
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An exit interview was conducted and plans of Corrections were developed. A copy of this report and appeals rights were provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 11-AS-20220131083928
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: FRANK'S ADULT RESIDENTIAL HOME
FACILITY NUMBER: 191640255
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2022
Section Cited
CCR
80075(l)(1)(A-D)
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Health Related Services. Prescription medications...which are not to be retained shall be destroyed by the facility administrator, or a designated substitute, and one other adult who is not a client. Both shall sign a record, to be retained for at least one year, which lists the following:...The date of destruction.
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The admiistrator agreed to destroy the medications and submit a plan to ensure that medications which are not to be retained are destroyed. Proof of correction will be submitted by POC due date.
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This requirement was not met as evidenced by: Based on LPA observation the licensee failed to ensure that mecidations which are not to be retained are destroyed. LPA observed C1 and C2's medications from October to December cycle were not destroyed, which poses a potential health and safety risk to clients in care.
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Type B
02/15/2022
Section Cited
CCR
85076(d)(1)
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Food Service. The licensee shall meet the following food supply and storage requirements:
non perishable foods for a minimum of one week and fresh perishable foods for a minimum of two days shall be maintained on the premises.
This requirement was not met as evidenced by:
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The administrator agreed to dispose of expired food supply and buy staple non-perishable food supply to meet the one weeks supply requirment and submit a plan to nsure that a supply of staple nonperishable foods for a minimum of one week is maintained on the premises. Proof of correction will be submitted by POC due date.
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Based on LPA observation the licensee failed to ensure that a supply of staple nonperishable foods for a minimum of one week is maintained on the premises, during todays visit LPA's Coronel and Randle observed expired non perishable foods which reduced the supply to less than one weeks worth, whicha potential health and safety risk to clients 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.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 11-AS-20220131083928
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: FRANK'S ADULT RESIDENTIAL HOME
FACILITY NUMBER: 191640255
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2022
Section Cited
CCR
80061(b)(1)(E)
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Reporting Requirements. Upon the occurrence... a report shall be made... within the agency's next working day...hours. In addition, a written report...within seven days following the occurrence of such event. Events reported shall include the following: Any...absence ...of any client.
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The administrator agreed to create a plan to ensure that unusual incident reports are submitted to Licensing in a timely manner. Proof of correction will be submitted by POC due date.
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This requirement was not met as evidenced by: Based on record reviews the licensee failed to ensure that incident reports are submitted to the department, a report was not made regarding C2's missing persons incident on 07/01/2021 which poses a potential health and safety risk to clients in care.
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Type B
03/01/2022
Section Cited
CCR
80087(a)
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Buildings and Grounds. The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
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The administrator agreed to have the said items repaired. Proof of correction will be submitted by POC due date.
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Based on observation, the licensee did not comply with the section cited above, the refrigerator, the linoleum floors, the light switch , the paint on the ceiling, the door knob and the window in bedroom #3 are in disrepair. Which poses a potential heal and safety risk to clients 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.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
LIC9099 (FAS) - (06/04)
Page: 7 of 7