197607231-9-1-2021-11-AS-AJKK-C7JM2E-20211006091323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607231
Report Date: 09/01/2021
Date Signed: 09/01/2021 02:54:39 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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2021 and conducted by Evaluator Jey Cardenas

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210714142115

FACILITY NAME:	A HELPING HAND SOUTH BAY		FACILITY NUMBER:	197607231
ADMINISTRATOR:	SUSAN COOPER		FACILITY TYPE:	740
ADDRESS:	4848 134TH PL.		TELEPHONE:	(310) 973-1315
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY:	6	CENSUS: 6	DATE:	09/01/2021
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Sue Cooper		TIME COMPLETED:	10:34 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff mishandles a resident's medication

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPA) Jey Cardenas conducted a subsequent complaint visit to deliver findings for the allegation listed above. Upon arrival at the facility LPA conducted a risk assessment over the telephone with administrator, Sue Cooper; based on the assessment, the facility is clear of Covid-19 infection. LPA met with Miss Cooper, the purpose of the visit was explained.
Investigation consisted of: LPA toured physical plant, conducted interviews with Administrator, Miss Cooper and staff, reviewed resident files and medication.

It is alleged that the facility was requesting an early refill for Resident 1 (R1) Risperidone liquid because the facility uses the medication for other resident living at the facility.

Re: allegation Staff mishandles a resident's medication. On 7/26/21 LPA Cardenas reviewed residents Medication administration Record (MAR) and observed that R1 and R2 both have prescription for Risperidone. Per doctors’ orders R1 Risperidone should be given .125ML by mouth two times a day,

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jey Cardenas	TELEPHONE: (323) 383-8188
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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 11-AS-20210714142115

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
MONTERY PARK, CA 91754

FACILITY NAME: A HELPING HAND SOUTH BAY	FACILITY NUMBER: 197607231
	VISIT DATE: 09/01/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

may give another .125ML as needed for agitation at night. Per doctors’ orders R2 should be given ½ML in the morning and 1 ML at bedtime. LPA reviewed medication and observed that both R1 and R2 have Risperidone medication at the facility, each bottle has quantity of 30ML. LPA reviewed R1’s mail order pharmacy dated 3/17/21 for Risperidone Oral solution Med Qty 30ML, second mail order pharmacy dated 6/4/21 Risperidone Med Qty 30ML. R2’s Risperidone oral solution dated 3/29/21 was distributed with Qty of 150ML.
Based on information gathered, LPA did not find sufficient evidence to support the allegation above. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED.
An exit interview was conducted

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jey Cardenas	TELEPHONE: (323) 383-8188
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2