197608859-8-25-2023-11-AS-MVAO-CWXQEW-20231025120701

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608859
Report Date: 08/25/2023
Date Signed: 08/25/2023 11:07:19 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/01/2023 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230801112630

FACILITY NAME:	EILAT'S MANOR		FACILITY NUMBER:	197608859
ADMINISTRATOR:	MIRIAM RUDES		FACILITY TYPE:	740
ADDRESS:	1621 S. SHERBOURNE DRIVE		TELEPHONE:	(310) 273-3133
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	6	CENSUS: 6	DATE:	08/25/2023
		UNANNOUNCED	TIME BEGAN:	10:42 AM
MET WITH:			TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are not adequately trained.
Staff are sleeping in common areas at the facility.
Staff do not accurately give residents their medications.
Staff do not lock medications up at the facility.
Staff do not lock up cleaning supplies at the facility.
Staff are not accurately reporting incidents at the facility.

INVESTIGATION FINDINGS:

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On 08/10/23, Licensing Program Analyst (LPA), Perry Scott conducted a 10-day complaint investigation at the facility listed above. LPA met with Eilat Nahum, Administrator, and Susy Susanto, caregiver, and explained the purpose of today’s visit was to investigate the allegations listed above.

On 08/10/23, the investigation consisted of the following:

During today's visit LPA toured the facility. LPA requested and obtained copies of the following documents: Resident and Staff Roster, Staff Training, Incident Reports, and Training Certificates. LPA interviewed staff (S1-S2) and residents (R1-R3).

The investigation revealed the following: Regarding allegation #1: Staff are not adequately trained.

On 08/10/23, LPA interviewed S1-S2. 2 of 2 staff denied the allegation that Staff are not adequately trained. All staff confirmed that they are trained on hospice, dementia, personal rights, medication, and a host of other trainings. They stated that they have training monthly. LPA reviewed the training records for staff and verified that they have the required trainings. R1-R3 stated that they were satisfied with the care the staff gives them.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

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 11-AS-20230801112630

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: EILAT'S MANOR	FACILITY NUMBER: 197608859
	VISIT DATE: 08/25/2023

NARRATIVE

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Based on interviews, and records reviewed there is insufficient evidence to support the allegation: Staff are not adequately trained. 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.

Allegation #2: Staff are sleeping in common areas at the facility.

On 08/10/23, LPA interviewed S1-S2. 2 of 2 staff denied the allegation that Staff are sleeping in common areas at the facility. All staff state that the staff takes their breaks in the staff room. R1-R3 corroborate that the staff takes their break in the staff room.

Based on interviews, there is insufficient evidence to support the allegation: Staff are sleeping in common areas at the facility. 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.

Allegation #3: Staff do not accurately give residents their medications.

On 08/10/23, LPA interviewed S1-S2. 2 of 2 staff denied the allegation that Staff do not accurately give residents their medications. All staff state that they give the accurate medication to all residents. They further state that when medication is given it is documented on the Medication Administration Record with dates and times. R1-R3 stated that they receive their medication as prescribed.

Based on interviews and a record review, there is insufficient evidence to support the allegation Staff do not accurately give residents their medications. 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.

Allegation #4: Staff do not lock medications up at the facility.

On 08/10/23, LPA interviewed S1-S2. 2 of 2 staff denied the allegation that Staff do not lock medications up at the facility. All staff state that the medication is kept in a locked room in the living room; and it is always locked. LPA verified that the medications were locked at the time of the visit. R1-R3 corroborated with staff that the medication is kept locked in the living room.

Based on interviews and observations, there is insufficient evidence to support the allegation Staff do not lock medications up at the facility. 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.

Report continued on LIC9099-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230801112630

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: EILAT'S MANOR	FACILITY NUMBER: 197608859
	VISIT DATE: 08/25/2023

NARRATIVE

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Allegation #5: Staff do not lock up cleaning supplies at the facility.

On 08/10/23, LPA interviewed S1-S2. 2 of 2 staff denied the allegation that Staff do not lock up cleaning supplies at the facility. All staff state that chemicals and cleaning supplies are always kept in a locked cabinet in the facility. And when the items are used, they are returned to the locked cabinet. LPA toured the facility and verified that all chemicals and cleaning supplies have a designated cabinet where it is locked, when not in use. All chemicals and cleaning supplies were locked on this visit. R1-R3 corroborated with staff that the cleaning supplies are kept in a locked cabinet.

Based on observations and interviews, there is insufficient evidence to support the allegation Staff do not lock up cleaning supplies at the facility. 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.

Allegation#6: Staff are not accurately reporting incidents at the facility.

On 08/10/23, LPA interviewed S1-S2. 2 of 2 staff denied the allegation that Staff are not accurately reporting incidents at the facility. All staff state that when there is an incident at the facility, they report it to Community Care Licensing to document the incident. They further state that there has not been an incident in some time.

Based on interviews, and records reviewed there is insufficient evidence to support the allegation Staff are not accurately reporting incidents at the facility. 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.

No deficiencies were cited.

An exit interview was conducted, and a hard copy of this report was provided to Miriam Rudes, administrator.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

LIC9099 (FAS) - (06/04)

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