197608203-7-24-2023-28-AS-RORN-CUALDX-20230801084038

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608203
Report Date: 07/24/2023
Date Signed: 07/24/2023 01:49:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2022 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221028124235

FACILITY NAME:	ELIM HEALTHCARE, INC.		FACILITY NUMBER:	197608203
ADMINISTRATOR:	TAMMIE CHA		FACILITY TYPE:	740
ADDRESS:	1126 S. WESTMORELAND AVENUE		TELEPHONE:	(213) 736-7777
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90006
CAPACITY:	142	CENSUS: 124	DATE:	07/24/2023
		UNANNOUNCED	TIME BEGAN:	09:46 AM
MET WITH:	Jean Kim - Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff threatened resident's.
Staff made inappropriate comments towards resident's.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted a follow up complaint investigation regarding the allegations listed above. LPA met with Administrator Jean Kim and explained the reason for the visit. Administrator Tammie Cha later assisted with the visit.

The investigation consisted of the following: during the initial visit conducted on 11/07/22, LPA Kruz Long obtained a copy of the Staff/Resident rosters, and interviewed Staff #1-6 (S1-S6).
During subsequent visit conducted today 7/24/23, LPA Tena Herrera obtained the following documents: Staff Roster, Resident Roster, Personal Rights training log for Staff, list of last 5 residents who were admitted to skilled nursing facilities and reasons behind it, and interviewed Administrator Jean Kim, S7-S11 and Residents #1-10 (R1-R10).

(continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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 28-AS-20221028124235

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ELIM HEALTHCARE, INC.	FACILITY NUMBER: 197608203
	VISIT DATE: 07/24/2023

NARRATIVE

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The investigation revealed the following:
Allegation: Staff threatened residents.
It was reported that staff allegedly threatens residents when they have a complaint by stating they will send the resident to a skilled nursing facility, and have sent a resident to a skilled nursing home for no reason. After record review and interviews with S1-S11; it was explained that transfers to skilled nursing facilities are doctor ordered and are not based on the discretion of the staff. Reviews of the last five transfers to skilled nursing facilities were due to need of extra medical attention and were sent to emergency room from there discharged to skilled nursing facility. Interviews with R1-R11 all denied the above allegation and stated that they have never been threatened, given ultimatums nor have they been mistreated by any staff.

The investigation revealed the following:
Allegation: Staff made inappropriate comments towards resident's.
It was reported that staff allegedly use inappropriate language towards residents. During interviews with S1-S11 and R1-R10, all denied the above allegation. Record review showed that S1-S11 have all been trained in Residents Personal Rights, last training was conducted on 6/13/23. During interviews with S1-S11 all stated that they have never yelled at a resident or made any inappropriate comments towards residents. During interviews with R1-R10, 10 out of 10 residents stated that they have never been yelled at, spoken to inappropriately or treated inappropriately by staff.

Based on statements and interviews conducted with staff, residents, and facility file reviews, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC9099 (FAS) - (06/04)

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