197608604-6-18-2024-28-AS-RORN-D6LLH6-20240626084549

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608604
Report Date: 06/18/2024
Date Signed: 06/18/2024 01:47:31 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
06/11/2024 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20240611142720

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:	06/18/2024
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Darolyn Azevedo, administrative assistant		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff are not accepting resident back after hospital stay.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation for the allegation listed above. LPA met with Darolyn Azevedo, administrative assistant and explained the purpose of today's complaint investigation visit.

The investigation consisted of the following: during the investigation visit, LPA obtained staff/resident roster, reviewed/obtained resident#1’s (R1) records, interviewed residents from resident#2 (R2) to resident#6 (R6), attempted but unable to reach resident#1 (R1) for interview, interviewed staff from staff#1 (S1) to staff #6 (S6), and conducted a physical plant.

The investigation revealed the following:
In regard of allegation, staff are not accepting resident back after hospital stay, it was alleged that the facility did not take resident back after the hospital stay.
(-continued in LIC9099C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

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-20240611142720

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: 06/18/2024

NARRATIVE

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LPA interviewed residents, five (5) out of five (5) residents stated residents could not corroborate the allegation. Resident interviews revealed the facility would take residents back from hospital stay. All six (6) staff interviewed denied the allegation. Staff interviews revealed staff would take residents back when residents were discharged from hospitals. It was resident#1's (R1) own will of not returning to the facility. Resident had admitted to another facility. Per record review, resident’s records indicated resident did not want to return to the facility by resident's own will. Thus, staff did not fail to accept resident back after hospital stay.

Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Darolyn Administrator assistant and findings were discussed. A copy this report was provided to Administrator at time of visit.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC9099 (FAS) - (06/04)

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