197608604-7-21-2023-28-AS-RORN-CUBVHK-20230802162716

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608604
Report Date: 07/21/2023
Date Signed: 07/21/2023 11:51:15 AM

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
06/20/2022 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220620111203

FACILITY NAME:	PROMISE ASSISTED LIVING, LLC.		FACILITY NUMBER:	197608604
ADMINISTRATOR:	GREGORY Z. RESTUM		FACILITY TYPE:	740
ADDRESS:	1231 SOUTH ALVARADO STREET		TELEPHONE:	(310) 205-2591
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90006
CAPACITY:	22	CENSUS: 22	DATE:	07/21/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Teisha Lields - Caregiver		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Resident is physically abuse.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation regarding the allegation listed above. LPA met with Teisha Lields and explained the reason for the visit. Assistant Administrator Dee Azevedo arrived shortly thereafter.

The investigation revealed the following: during the initial visit conducted on 06/27/2022,LPA Alma Gonzalez conducted interviews with Assistant Administrator Dee Azevedo, collected copies of Staff and Resident Rosters, toured the facility reviewed Resident 1 (R1) facility file and collected copies of the following documents: Identification and Emergency Information, Preplacement Appraisal Infomation, Resident Appraisal, Physician's Report For Residential Care Facilities For The Elderly (RCFE). During today's visit, LPA Zaragoza interviewed Staff #1 - #5 (S1, S2, S3, S4, S5), Residents #2 - #7 (R2, R3, R4, R5, R6, R7), and attempted to interview Resident #1 (R1) however R1 is no longer a reisdent of the facility and the whereabouts of R1 are unknown. LPA also obtained copy of the current Resident Roster.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

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-20220620111203

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: PROMISE ASSISTED LIVING, LLC.	FACILITY NUMBER: 197608604
	VISIT DATE: 07/21/2023

NARRATIVE

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The investigation revealed the following: in regards to the allegation "Resident is physically abuse.", it is alleged that S1 punched R1 after R1 asked to leave the facility which left a cut on her lip. During an interview with S1 over the phone, S1 explained that she never punched R1 or any other residents at the facility, and she explained that R1 was having a manic episode in which she climbed out a second story window onto the roof of the facility, and cut her lip on the window pane climbing back into the facility from the same window. During interviews with the residents, R2 - R7, five (5) out of six (6) residents could not corroborate the allegation that staff have physically abused residents in care. R2, R3, R5, and R6 explained that they have not witnessed or heard of the staff hitting residents in the facility, and that staff have treated them and the other residents well in their experience and have not had any issues with them. During interview with S2 and S3, they described how R1 had not been taking her medications during her stay at the facility, and that she had accused the staff of things which had never occurred to the police and other agencies. S1 - S5 all denied that staff have punched or otherwise put their hands on the residents.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, 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: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

LIC9099 (FAS) - (06/04)

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