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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608203
Report Date: 09/24/2021
Date Signed: 09/24/2021 04:00:01 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 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
09/30/2020 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20200930114828
FACILITY NAME:ELIM HEALTHCARE, INC.FACILITY NUMBER:
197608203
ADMINISTRATOR:TAMMIE CHAFACILITY TYPE:
740
ADDRESS:1126 S. WESTMORELAND AVENUETELEPHONE:
(213) 736-7777
CITY:LOS ANGELESSTATE: CAZIP CODE:
90006
CAPACITY:142; 142CENSUS: 70DATE:
09/24/2021
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Administrator Tammie ChaTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff do not safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint visit for the allegation above. LPA met with Administrator Tammie Cha and explained the purpose of the visit.

The initial investigation was conducted on 10/7/20 and consisted of: LPA conducted a telephone interview with Staff #1-#2 (S1-S2) and conducted a virtual tour of the physical plant. LPA requested/ received copies of Staff and Resident Rosters, and copies of pertinent documents related to complaint allegations.

On todays visit, LPA conducted interviews with Staff #3-#6 (S3-S6), LPA was unable to interview Resident #1 (R1) as R1 is no longer in the facility. LPA reviewed R1's file.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
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 28-AS-20200930114828
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ELIM HEALTHCARE, INC.
FACILITY NUMBER: 197608203
VISIT DATE: 09/24/2021
NARRATIVE
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The investigation revealed the following: In regards to the allegation, "Staff do not safeguard resident's personal belongings" it was alleged that R1's money and personal belongings were being stolen by staff. (6) of (6) staff interviewed denied the allegation. Review of resident documents does not show that the facility managed R1's money or was entrusted to safeguard residents personal property. Interviews show that when visitors leave money or items to the residents they visit, the staff are not made aware of what they are given. LPA was unable to interview R1 for more information due to R1 no longer being available to contact. Based on interviews conducted with facility staff, LPA review of records and observations, there was not enough supportive evidence to concur with the reported allegation; therefore, the allegation is UNSUBSTANTIATED.

A copy of this report was provided to administrator Tammie Cha.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2