197608374-5-16-2025-11-AS-JHAD-DHPTL8-20250616144905

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608374
Report Date: 05/15/2025
Date Signed: 05/16/2025 04:56:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/16/2024 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240516220152

FACILITY NAME:	IN HONOR OF OUR PARENTS, INC.		FACILITY NUMBER:	197608374
ADMINISTRATOR:	ANGELA LOVE		FACILITY TYPE:	740
ADDRESS:	1317 W. 40TH PLACE		TELEPHONE:	(323) 296-7816
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90037
CAPACITY:	6	CENSUS: 5	DATE:	05/15/2025
		UNANNOUNCED	TIME BEGAN:	09:17 AM
MET WITH:	Angela Love		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not prevent a resident from developing pressure injuries
Staff do not have adequate record keeping.

INVESTIGATION FINDINGS:

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On May 15, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPAs) Ernand Dabuet and Perry Scott conducted a subsequent visit to gather information regarding the above allegations. LPA met with the administrator, Angela Love, and explained the purpose of the visit. LPAs were granted entry to the facility.

The investigation consisted of the following: An initial complaint visit was completed by the Department on 05/20/24 to obtain facility files. The Department conducted A subsequent visit on 05/15/25 to interview staff and residents. The Department investigated the allegations mentioned in this complaint and conducted interviews with staff (S1-S4), residents (R1-R5), and witnesses (W1-W3). The following records: Resident Roster, Staff Roster, Resident Appraisals (dated 09/13/1, 03/04/08, 12/08/23), IID/Emergency Information (dated 11/16/23, 12/08/23), Physicians Reports (dated 09/12/22, 08/09/24, 09/12/22, 08/24/23, 01/26/24), and other records pertinent to this complaint.
(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

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 11-AS-20240516220152

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: IN HONOR OF OUR PARENTS, INC.	FACILITY NUMBER: 197608374
	VISIT DATE: 05/15/2025

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff did not prevent a resident from developing pressure injuries.

The complaint alleges that the facility staff did not prevent Resident #1 (R1) from developing pressure injuries. It is reported that the residents in care developed pressure injuries that could have been prevented by staff. According to reports, (R1) developed two wounds, categorized as stage 2 and stage 3. No additional information was provided regarding these allegations.

A review of Resident #1 (R1)’s Identification and Emergency Information LIC 601 (dated November 11, 2023) indicates that (R1) was admitted to In Honor of Our Parents, Inc. on that date. Previously, (R1) was on Benevolent Home Health from July 09, 2024, through September 01, 2024. During (R1)’s home health treatment services, (R1) was not diagnosed with any pressure injuries. (R1) Home health services were to assist with Activities of Daily Living (ADLs).

On May 15, 2025, between 10:00 AM and 2:00 PM, the Department interviewed resident members identified as Resident #1 through Resident #5 (R1-R5). Three (3) out of the five (5) denied ever having pressure injuries. (R1) asserted to have never had any bed sores. (R2 and R5) were interviewed, but their health conditions hindered their ability to engage in conversation. Despite the effort to communicate, their medical condition limited their dialogue.

On May 15, 2025, between 10:00 AM and 2:00 PM, the Department interviewed staff members identified as Staff #1 through Staff #4 (S1-S4). Four (4) out of the four (4) staff members could not corroborate this allegation. Staff members (S1-S4) reported that no residents in care have ever developed bedsores. (S1) stated that residents in care have static air mattresses that prevent pressure sores due to limited mobility. Residents are repositioned every two hours to prevent pressure injuries, and staff received training from hospice and home health on how to avoid these injuries.

On May 13, 2025, and May 15, 2025, between 10:40 AM and 2:00 PM, the Department interviewed witness members identified as Witness #1 through Witness #3 (W1-W3). Three (3) out of the three (3) witness members could not verify the allegation. (W1) the Program Director at Morningside Adult Day Health, characterized (R2, R3, and R5) all to be well groomed and cared for by staff and unaware of bedsores. (W2 and W3) Home Health Services representatives verified that (R1) was never treated for pressure injuries and that no wound care plan was ever established to be included in (R1’s) care plan.
(Evaluation Reports continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240516220152

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: IN HONOR OF OUR PARENTS, INC.	FACILITY NUMBER: 197608374
	VISIT DATE: 05/15/2025

NARRATIVE

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The Department reviewed Resident #1's (R1) Physician's Report LIC 602A, (dated 08/24/24) and the Resident Appraisal (dated 11/16/23). These documents indicated that (R1) had no history of skin conditions or breakdowns. Additionally, an examination of the Physician Reports LIC 602A for Residents #2 through #5 (dated 09/12/22, 01/26/24, and 08/09/24) showed no history of skin conditions or breakdowns for any of these residents.

A further review of (R1)'s medical records from Benevolent Home Health (covering 07/09/24 to 09/01/24) confirmed that (R1) had not received treatment for any pressure injuries nor was there was an established wound care include in the care plan.

During a May 15, 2025, visit the Department observed that the facility provided residents with static air mattresses.

Based on the information collected, insufficient evidence supports the allegation mentioned above.

Allegation #9: Staff do not have adequate record keeping.

The complaint alleges that the facility failed to maintain accurate records of staff and residents. No further details were provided regarding this allegation.

On May 15, 2025, between 09:30 AM and 12:00 PM, the Department thoroughly audited the resident records for individuals designated as Resident #1 through Resident #5. Upon review, it was discovered that each resident's service record was maintained and included all necessary documents mandated by the Community Care Licensing regulations. This review ensured that the residents' files complied with the established legal requirements.

On May 15, 2025, between 09:30 AM and 12:00 PM, the Department thoroughly audited the staff records for individuals designated as Staff #1 through Staff #4. An examination revealed that each staff member's record was maintained correctly and included all required documents specified by Community Care Licensing regulations. This review confirmed that the staff files adhered to the established legal standards.

Based on the information collected, insufficient evidence supports the allegation mentioned above.

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. While the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegations are determined Unsubstantiated.

An exit interview was conducted with Angela Love, and copies of the reports were provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

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