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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608604
Report Date: 01/23/2024
Date Signed: 01/23/2024 10:46:54 AM

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
09/27/2022 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220927115755
FACILITY NAME:PROMISE ASSISTED LIVING, LLC.FACILITY NUMBER:
197608604
ADMINISTRATOR:GREGORY Z. RESTUMFACILITY TYPE:
740
ADDRESS:1231 SOUTH ALVARADO STREETTELEPHONE:
(310) 205-2591
CITY:LOS ANGELESSTATE: CAZIP CODE:
90006
CAPACITY:22CENSUS: 21DATE:
01/23/2024
UNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Roxana AparicioTIME COMPLETED:
10:50 AM
ALLEGATION(S):
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Resident was sexually assaulted while in care.
Residents are being mentally and physically abused by staff.
Residents needs are not being met by the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted a subsequent visit to deliver findings on the investigation conducted by DSS Investigation Branch (IB) Investigator Laura Garcia. LPA explained the purpose of the visit to Supervisor Roxana Aparicio.

The investigation consisted of: On 9/28/22, LPA Galarza conducted a physical plant tour of the facility, obtained file documents, and reviewed staff and resident files. Staff (S1)/Administrator and staff (S5 & S6) were interviewed. Copies of resident (R1-R3) and staff (S2- S3) file documents were obtained, as well as LIC 500 Personnel Report, Register of Facility Clients/Residents, incident reports, and a list of staff phone numbers. IB investigator interviewed staff (S1-S4) and residents (R2-R3), and conducted a law enforcement inquiry. LPA inter During today's visit, LPA conducted a physical plant tour and interviewed non-ambulatory residents R4- R6.

***Narrative continues next page.*****

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
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 3
Control Number 28-AS-20220927115755
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: PROMISE ASSISTED LIVING, LLC.
FACILITY NUMBER: 197608604
VISIT DATE: 01/23/2024
NARRATIVE
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Allegation: Resident was sexually assaulted while in care. It is alleged that resident (R1) was raped at the facility by an unknown perpetrator. Investigations Branch (IB) investigator L. Garcia conducted the investigation. Resident (R1) only resided at the facility a total of four (4) days [6/10/22 - 6/14/22], and there were no complaints reported to staff of alleged sexual abuse. A total of six (6) staff were interviewed, of which all denied having knowledge of alleged rape/alleged sexual abuse of resident (s). Staff revealed that there are some residents that are intimate with each other and in a relationship. It is assumed their relationship is consensual because no reports of rape or sexual abuse have been report. Per file review, R1 has history of schizophrenia and paranoia. Staff (S3) stated that on one occasion they witnessed resident (R1) saying that a man was behind trying to kill the resident, but there was no one around. Resident (R1) was not interviewed because they moved out, and after several attempts to contact R1, and interview was not possible. IB investigator interviewed residents (R2 & R3); both denied sexual abuse or knowledge of sexual abuse incidents. A law enforcement search inquiry was made, however, no relevant information or current address location was obtained for resident (R1). Based on interviews conducted and record review, the findings indicate that there is insufficient evidence to corroborate the allegation.

Allegation: Residents are being mentally and physically abused by staff. It is alleged that staff hit residents and are verbally abusive to residents. It was reported that in the past one (1) staff (S7) fought with a resident (unknown name) with their fist. It is also alleged that supervisor/staff (S3) has been overheard calling resident(s) "bitch". It was also reported that a night shift staff (S8) accidentally dropped resident (R2), and that supervisor/staff (S3) and S8 told R2 to say they were hit and not dropped. Three (3) staff, [staff S2, S3, and S7] were reported to be verbally and physically abusive to residents. Staff (S2 & S3) denied the witnessing or engaging in abuse. Administrator/staff (S1) stated that two (2) staff were fired the week prior to this complaint being filed, and they told Administrator they were going to file a complaint. A copy of Employee Disciplinary Action Form was provided to investigator, stating that staff (5) was fired due to threats and harassment of residents. A total of two (2) residents were interviewed, both R2 & R3 stated that they have not been victims of mental or physical abuse. Resident (R2) denied sustaining injuries from either neglect or abuse by any of the staff members, and also denied ever witnessing any type of abuse by any of the staff or residents or hearing any rumors of abuse. One (1) out of six (6) staff interviewed stated that staff are verbally and physically abuse. However, there is insufficient evidence to prove the allegation.

*See next page.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220927115755
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: PROMISE ASSISTED LIVING, LLC.
FACILITY NUMBER: 197608604
VISIT DATE: 01/23/2024
NARRATIVE
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Allegation: Residents needs are not being met by the facility. It is alleged that residents are not being provided feeding assistance, receiving incontinence care as directed, staff do not wash the resident's clothes, and are not being provided transfer assistance into their wheelchairs. A total of six (6) staff were interviewed, of which all denied neglect of care and supervision. According to staff, non-ambulatory residents are assisted with incontinence care, bathing, and basic needs. A total of six (6) residents were interviewed. Resident interviews revealed that staff assist with Activities of Daily Living (ADL's) as required, and that they are satisfied with the level of care provided by staff.

Based on interviews conducted and record(s) review, there was insufficient evidence to prove the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview was conducted with Roxana Aparicio. *Only the 1st page of the report was printed. There were printing technical issues. The entire report will be emailed & mailed.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3