197608604-8-5-2021-28-AS-FFIS-CDPTNH-20220421145247

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608604
Report Date: 08/05/2021
Date Signed: 08/05/2021 04:25:11 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
07/29/2021 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210729084611

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: 19	DATE:	08/05/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Assistant Administrator D'arolyn Azevedo and Administrator Gregory Restum		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff deny telephone access to resident
Staff refused to provide resident its cash resources
Staff made resident sign an advance directive without notifying resident's responsible person.
Staff refuse to provide activities to resident in care
Facility has pests
Staff did not assist resident with showers
Staff made inappropriate comments towards resident
Staff did not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an initial unannounced complaint visit to investigate the above allegations. LPA was allowed entry by Staff #1 (S1). At approximately 11:50 A.M, the Assistant Administrator D'arolyn Azevedo arrived to assist with this visit. LPA spoke to the Facility Administrator Gregory Restum via telephone LPA discussed the purpose of today's visit.

The following occurred during this investigation: LPA toured the physical plant between 12:10pm-1pm, LPA obtained copies of the Staff and Resident Rosters. At approximately 1pm, LPA reviewed Resident files for Resident #1 (R1) and obtained relevant information. Between 11:35am- 2:15pm LPA interviewed Staff #1-#4 (S1-S4)and Residents #1-#5 (R1-R5).

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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-20210729084611

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: 08/05/2021

NARRATIVE

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The investigation revealed the following: In regards to the allegation, "Staff deny telephone access to resident" it was alleged that S1 refused to give telephone access to R1 in the facility and instructed other staff to do so. (4) of (4) staff denied the allegation. (4) of (5) residents could not corroborate the allegation. The facility has a phone that is available for resident use when needed and when residents receive phone calls. LPA did not observe staff deny telephone use to residents at the time of visit. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to allegation "Staff refused to provide resident its cash resources" it was alleged that facility staff did not provide R1 with their monthly allowance. (4) of (4) staff denied the allegation. (4) of (5) residents could not corroborate the allegation. Review of R1's file show that the facility does not manage R1's finances. Interviews show that R1 receives their Social Security income monthly and pays rent themselves. LPA was not provided information that staff refused to provide resident with cash resources. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation "Staff made resident sign an advance directive without notifying resident's responsible person." it was alleged that staff had R1 sign an advance medical directive without notifying R1's responsible party. (4) of (4) staff denied the allegation. (4) of (5) residents could not corroborate the allegation. Review of R1's file shows that R1 does not have a responsible party on file who would need to have been notified. R1's file shows that R1 is responsible for themselves. R1's file also does not have the alleged signed directive. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation "Staff refuse to provide activities to resident in care" its was alleged that facility staff did not assist R1 out of bed and to participate in activities. (4) of (4) staff denied the allegation. (4) of (5) residents could not corroborate the allegation. Interviews show that the facility has an activity schedule for the residents and an area for activities but the residents do not participate. Staff do not refuse to provide the activities listed on schedule. LPA observed staff reminding residents of what activities they may participate in if they choose. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Continued on LIC 9099-C

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210729084611

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: 08/05/2021

NARRATIVE

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In regards to the allegation "Facility has pests", it was alleged that there are fleas in the facility. (4) of (4) staff denied the allegation. (4) of (5) residents could not corroborate the allegation. Interviews with staff indicated that the facility and bedrooms are cleaned daily to prevent any pests. Room #22, #10, #7 and #13 were inspected and LPA did not observe any sign of fleas or other pests. LPA reviewed the Global Rodent and Pest Control service contract provided that states monthly services for prevention of multiple pests but does not state that there is an ongoing issue currently. The Administrator stated that the monthly pest control services includes treating for fleas. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation "Staff did not assist resident with showers" it was alleged that R1 was not being provided showers by the facility staff. (4) of (4) staff denied the allegation. (5) of (5) residents could not corroborate the allegation. Interviews show that R1 had scheduled bath times twice a week and was always assisted by facility staff. Review of R1's file shows that R1 does in fact need assistance with bathing as well. Based on interviews conducted, staff assisted R1 with bathing when needed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation "Staff made inappropriate comments towards resident" it was alleged that S1 would make unprofessional comments to R1. (4) of (4) staff denied the allegation. (4) of (5) residents could not corroborate the allegation. interviews show that there were no witnesses to the alleged unprofessional comments. There are no staff notes regarding S1 ever making unprofessional comments to residents in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation "Staff did not safeguard resident's personal belongings" it was alleged that staff were possibly taking R1's personal belongings. (4) of (4) staff denied the allegation. (4) of (5) residents could not corroborate the allegation. Review of R1's file shows that R1's personal belongings only consisted of clothing. It was not alleged that clothing was taken but that R1's money was. The facility did not handle the cash resources for R1. LPA was not provided evidence of the allegation occurring. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Staff Roxana Aparicio and telephonically with Administrator Gregory Restum and a hard copy was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC9099 (FAS) - (06/04)

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