197602038-8-22-2023-31-AS-TAGD-D6YTMZ-20240708145158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602038
Report Date: 08/22/2023
Date Signed: 08/22/2023 02:15:41 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/17/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230817162558

FACILITY NAME:	FLOWERS RESIDENTIAL CARE FACILITY		FACILITY NUMBER:	197602038
ADMINISTRATOR:	RODERICK KIRK		FACILITY TYPE:	740
ADDRESS:	2762 VISSCHER PLACE		TELEPHONE:	(626) 797-7996
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	6	CENSUS: 5	DATE:	08/22/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Kirk Roderick - Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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9

Medication not issued as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit at this facility to investigate the above allegation. LPA met with Kirk Roderick and explained the reason for the visit.

LPA conducted physical plant tour 10:35 AM, requested copy of facility documents relevant to the investigation at 11:12 AM and interviewed staff and residents between 11:30 AM to 1:00 PM. It was alleged that Resident #1 (R1) was not given antibiotics medication for two (2) days. LPA's record review revealed that R1 was prescribed antibiotics after hospitalization on 07/29/23. LPA's interview with the staff revealed that R1 was given antibiotic 2x a day for the next seven (7) days beginning 07/30/23 as prescribed by R1's physician. LPA's interview with four (4) residents between 11:30 AM to 1:00 PM revealed that three (3) out of four (4) residents stated that they get their medication regularly and on time. One (1) resident refused to answer and pretended to be asleep while watching TV. Based on the information gathered during this visit. the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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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