197602038-8-4-2023-31-AS-TAGD-CY7Q6M-20231204105343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602038
Report Date: 08/04/2023
Date Signed: 08/04/2023 01:01:33 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, 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
07/25/2023 and conducted by Evaluator Melissa Ruiz

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230725100956

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: 6	DATE:	08/04/2023
		UNANNOUNCED	TIME BEGAN:	10:09 AM
MET WITH:	Roderick Kirk		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff did not assist Resident with their toileting needs.
Room temperature not maintained at a comfortable level.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melissa Ruiz conducted an unannounced complaint visit to investigate of the allegations listed above. Upon arrival, LPA met with the Administrator and explained the purpose of this visit. LPA conducted a walk-through of the facility, interviewed residents and the Administrator. LPA also obtained copies of pertinent documents relevant to the investigation.

Allegation: Staff did not assist Resident with their toileting needs.

It was alleged that one resident (R1) was observed to have dry feces on their body. To investigate this allegation, at 11:30 a.m., LPA observed R1 to be clean and free of any odors that would indicate they aren’t being assisted with their toileting needs. In addition, at 11:40 a.m. LPA attempted to conduct interviews with six (6) out of six (6) residents, and three (3) out of six (6) residents who were willing and able to communicate stated they get assistance from staff when needed. (cont. on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

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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Control Number 31-AS-20230725100956

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: FLOWERS RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 197602038
	VISIT DATE: 08/04/2023

NARRATIVE

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An interview with the administrator stated that they assist residents with their toileting needs as needed, and staff assist R1 at least twice a day. Due to insufficient information, we cannot determine if the allegation may or may not have occurred, therefore it is deemed unsubstantiated.

Allegation: Room temperature not maintained at a comfortable level.

It is alleged that the facility does not maintain the indoor temperature at a comfortable level, specifically the upstairs. To investigate the allegation, LPA conducted a physical plant walk through at approximately 11:00 a.m. and LPA did not observe central air conditioning throughout the facility. However, LPA observed ceiling fans and tower fans located throughout the facility. In addition, at 11:40 a.m. LPA attempted to conduct interviews with six (6) out of six (6) residents, and three (3) out of six (6) residents stated they were comfortable with the temperature at the facility. Based on LPA observation and interviews conducted, the allegation above is deemed unsubstantiated at this time.

No deficiencies observed. Report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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