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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608203
Report Date: 11/03/2022
Date Signed: 11/03/2022 12:45:44 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
10/24/2022 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20221024165259
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:142CENSUS: 122DATE:
11/03/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jean KimTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility not providing adequate care and supervision to resident's.
Staff discriminating against resident's.
Facility not meeting resident's dietary needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Rea conducted a visit in response to the above allegations. LPA met with Administrator, Jean Kim who assisted with today's visit.

The investigation consisted of interviews with Administrator, Staff #1- Staff #4, and resident #1-resident #4, tour of facility dining room, review of facility menu, and snack menu. Regarding the allegation that the facility is not providing adequate care and supervision to residents, Administrator and staff interviewed denied the allegation. They stated that on each shift, there are 1-2 caregivers per floor, and 2-3 caregivers on the memory care floor. Residents interviewed were unable to corroborate the allegation. Residents stated that the facility does provide adequate care and supervision to residents. Regarding the allegation that staff is discriminating against residents; Administrator and staff interviewed denied the allegation. They stated that staff treat all the residents equally and do not discriminate against any residents. Residents interviewed were unable to corroborate the allegation. Residents interviewed stated that staff treat them well and do not discriminate against them.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
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-20221024165259
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: 11/03/2022
NARRATIVE
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Regarding the allegation that the facility is not meeting residents' dietary needs, the investigation consisted of review of facility menu and snack menu, and review of list of residents' who have special dietary needs. Administrator and staff interviewed denied the allegation. Administrator stated that the facility has a contract with a catering company who delivers the residents meals. Administrator stated that the food that is provided to residents is in accordance with meeting the residents' dietary needs. Administrator stated that residents usually sit in the same area in the dining room, and the dining staff know which residents have special dietary needs. LPA observed that there is a list of residents, and their dietary needs are indicated on the list.

Based on LPA's observations and interviews, investigation revealed: 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.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Administrator, Jean Kim.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2