197608604-9-26-2023-28-AS-RORN-CWGT4X-20231010142437

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608604
Report Date: 09/26/2023
Date Signed: 09/26/2023 12:12:17 PM

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
09/30/2022 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220930134740

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:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Dee Azevedo		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Residents are using illegal drug substances while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Assistant Administrator Dee Azevedo and explained the reason for the visit.

The investigation consisted of: During the initial visit conducted on 10/03/22, LPA Gonzalez collected copies of Staff and Resident rosters. LPA also conducted a tour of entire facility inside and out with Staff 1 (S1). Facility tour consisted of observations of common areas, dining room, random resident rooms, bathrooms, patio area and kitchen. LPA observed residents in the facility, some residents were out in the patio area, in their rooms, in the lobby and dining room at the time of the visit. LPA observed the residents to identify any signs of neglect, abuse or other immediate Health and Safety threats. LPA did not observe any immediate

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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-20220930134740

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: 09/26/2023

NARRATIVE

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Health & Safety concerns during the visit. LPA reviewed R1-2 files and collected copies of documents pertinent to the investigation. LPA additionally interviewed R1 and R3. R2 was not interviewed as they were not available during LPA's visit. LPA interviewed Assistant Administrator Dee Azevedo and S1. On 10/06/22, Investigator Philippe Miles interviewed R1-2. On 09/26/23, LPA Gonzalez collected copies of Staff and Resident rosters. LPA also conducted a tour of entire facility inside and out with S2. Facility tour consisted of observations of common areas, dining room, random resident rooms, bathrooms, patio area and kitchen. LPA additionally interviewed R4-5, and S2-3.

Investigation revealed the following: Regarding allegation, Residents are using illegal drug substances while in care, it is alleged that facility staff are aware that multiple residents smoke illegal drugs inside of the facility grounds, in the north side patio area that is accessible through a side door near resident rooms. R1-2 reportedly smoke illegal drugs in that area of the facility. It is also alleged that a person by the name of "Tessa" comes to the facility at all times of the day and is also called to come to the facility by R2. There are allegedly other residents that use illegal drugs in the facility. Staff interviewed stated that they have not observed residents using illegal drugs inside the facility or out in the patio area. Staff interviewed stated that some residents may be using drugs while out in the community and stated that they have not heard of a person name "Tessa" coming into the facility property to sell illegal drugs to residents. Staff stated that only facility residents go out into the patio and when they have visitors the patio is also used. Staff stated that visitors check in for their visits in the office were they are screened. Interviews conducted with R1-4 revealed that they have never heard of or seen a drug dealer named "Tessa" selling illegal drugs to facility residents either inside or outside of the facility. R1-4 denied doing illegal drugs inside of the facility and also stated that they have not seen or heard of other residents doing illegal drugs inside of the facility. R2 stated that they do not use the facility phone and prefer to use their private phone when making private phone calls.

During facility tours, LPA observed residents in their rooms sleeping, in the common area watching television and also sitting outside in the patio area. LPA did not observe anything of concern. Based on statements gathered from interviews conducted with staff, residents, LPA record review and observations, there was not enough supportive evidence to concur with the reported allegation.

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.

Exit interview held. A copy of the report was provided to Assistant Administrator Dee Azevedo.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

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