197608604-6-22-2022-28-AS-MVAO-CJFSKG-20220920135644

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608604
Report Date: 06/22/2022
Date Signed: 06/22/2022 03:58:09 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
06/16/2022 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220616081341

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: 20	DATE:	06/22/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	D'arolyn Azevedo, Administrative Assistant		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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1. Resident sustained pressure wounds while in care.
2. Staff hit residents in care.
3. Residents are not being provided a safe environment.
4. Residents are being left in soiled diapers for an extended amount of time.
5. Facility not being cleaned.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted the complaint investigation for the allegations listed above. LPA arrived unannounced and met with D’arolyn Azevedo, Administrative Assistant. Administrator, Gregory Restum, arrived shortly thereafter. The purpose of the visit was explained.

LPA Chan obtained copies of the staff roster, resident roster, and list of residents with incontinence. LPA also toured the facility and inspected random rooms including the kitchen. Interviews were conducted with the Administrator, 5 Staff, and 7 residents.

The investigation revealed the following:
Allegation – Resident sustained pressure wounds while in care.
According to the Administrator, there are no residents with pressure wounds. 4 of the Staff interviewed have not seen any pressure wounds on residents. One staff stated a resident had a small scrape, smaller than a dime size, by the buttock area but did not have an open wound. The spot was treated immediately and was

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

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-20220616081341

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: 06/22/2022

NARRATIVE

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gone after a few days. LPA interviewed 7 residents of which 4 are incontinence. None of the residents interviewed stated that they have any pressure injuries nor pain in the buttock or back area.

Allegation – Staff hit residents in care.
Administrator and Staff interviewed denied hitting residents in care nor have they seen any staff hitting a resident. Staff stated they treat residents with respect and care for them. LPA interviewed 7 residents during today’s visit. One resident indicated that a staff slapped him/her in the face, while another resident stated that a staff was seen intentionally pushing another resident. There is no sufficient evidence to support this allegation.

Allegation – Residents are not being provided a safe environment.
Administrator Restum stated he and the staff monitor residents often to ensure they are safe. He has not heard of any resident being sexually or physically abused, otherwise, he will act immediately. None of the staff had seen any abuse and will report if they do see anything of such. They monitor all visitors entering the facility and have security cameras. Staff interviewed stated they check on residents as much as every 15 minutes to 2 hours, to ensure the residents are safe in the facility. Another staff stated that she requests for residents to let her know their whereabouts when they leave the facility in case of an emergency. 4 out of the 7 residents interviewed feel the facility provides a safe environment, while 3 of them do not. Two stated that they feel threatened by the staff’s words and actions which cause them to feel unsafe. The other one did not provide an explanation. There is no sufficient evidence to concur with this allegation.

Allegation - Residents are being left in soiled diapers for an extended amount of time.

Administrator and Staff denied the allegation. The facility does not keep a log when they change the residents but stated they check the residents diapers all day when they do their rounds. The care staff check on residents often and change them as needed. LPA interviewed 4 residents who are incontinence. 3 of the 4 residents stated staff change their diapers timely and they do not sit in soiled diapers for a long time.

(Continue on LIC9099C)

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20220616081341

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: 06/22/2022

NARRATIVE

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Allegation - Facility not being cleaned.
Per the Administrator, there is one housekeeper who cleans the bedrooms and bathrooms often in the day. As for the kitchen, the cook will clean the area and after dinner, the care staff takes over the cleaning. LPA interviewed the housekeeper who stated the bedrooms, hallways, bathrooms are cleaned throughout the day. During the visit today, LPA toured the facility and observed the housekeeper cleaning. LPA did not observe the bedrooms or bathrooms filthy or malodorous. All seven residents interviewed stated the housekeeper cleans their rooms and facility daily.

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.

An exit interview was conducted with Staff. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

LIC9099 (FAS) - (06/04)

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