197610169-5-25-2022-31-AS-MVAO-D42VJW-20240405162922

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610169
Report Date: 05/24/2022
Date Signed: 05/25/2022 01:09:10 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/16/2022 and conducted by Evaluator Melissa Ruiz

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20220516115132

FACILITY NAME:	BEYOND A HOME LLC		FACILITY NUMBER:	197610169
ADMINISTRATOR:	RICHARDSON, KESHA		FACILITY TYPE:	740
ADDRESS:	6023 WEST AVE L 12		TELEPHONE:	(661) 860-5048
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	6	CENSUS: 2	DATE:	05/24/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Kesha Richardson		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Facility is in disrepair.
Staff failed to provide residents with clean linens.
Staff failed to provide activities for residents in care.
Staff failed to meet residents' needs
Staff are neglecting residents in care.
Staff leave residents unattended in soaking wet diapers for extended periods.

INVESTIGATION FINDINGS:

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At 9:30 a.m., Licensing Program Analysts (LPAs) Melissa Ruiz and Angela Panushkina arrived at the facility to conduct an unannounced complaint visit. LPAs were greeted by staff and later met with the Administrator, Kesha Richardson. The purpose of the visit was explained, and an entrance interview was conducted.

To aid this investigation, LPAs toured the facility at 9:50 a.m. conducted interviews with the Administrator, three (3) staff and two (2) out of two (2) residents from 9:40 a.m., to 12:00 p.m. LPAs requested and reviewed pertinent documents related to this investigation. File review consisted of but was not limited to resident care plans, medication logs, hospital records, etc.

Allegation: Facility is in disrepair.
Upon conducting a physical plant tour, LPAs did not observe the facility to be in disrepair. Interviews with staff and Administrator revealed that there was never a time where the facility was in disrepair. Based on observation and interviews, this allegation is unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022

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 4

Control Number 31-AS-20220516115132

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BEYOND A HOME LLC	FACILITY NUMBER: 197610169
	VISIT DATE: 05/24/2022

NARRATIVE

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Allegation: Staff failed to provide residents with clean linens.

Upon touring the facility, LPAs observed all resident beds to have clean linens. LPAs observed a storage closet stored and maintained extra linens for use. An interview with the Administrator revealed that linens are changed at least once a week or as needed. Two (2) residents their linens are changed once a week. Based on observation and interviews, this allegation is unsubstantiated.

Allegation: Staff failed to provide activities for residents in care.

Interviews with three (3) staff revealed that although the two (2) residents in care do not like participate in physical activities, they do activities such as reading books and articles, puzzles, walks, and garden outside on a daily. Interviews with two (2) residents revealed that they like to read, listen to music, and walk outside. LPA also observed R2 participate in lunch preparation. Based on observation and interviews, this allegation is unsubstantiated.

Allegations: Staff failed to meet residents' needs.

Staff are neglecting residents in care.

To investigate these two allegations, LPA interviewed two (2) out of two (2) residents. Interviews with both residents revealed that there is a call button in their bedrooms, and when used, staff responds within a timely manner. R1 stated staff respond immediately to the call button. R2 has not used the call button yet, but staff is always available to assist them. Based on interviews, these allegations are unsubstantiated at this time.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20220516115132

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BEYOND A HOME LLC	FACILITY NUMBER: 197610169
	VISIT DATE: 05/24/2022

NARRATIVE

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Allegation: Staff leave residents unattended in soaking wet diapers for extended periods.

To investigate this allegation, LPAs interviewed two (2) out of two (2) residents. R1 stated that staff assist them with diaper changes within a timely manner. R2 stated that they are independent, and that they do not require assistance at this time. LPAs observed both residents to be well groomed, dressed, and clean. The Administrator stated that R1, who requires incontinence care is changed periodically every 2 hours. During the tour, LPAs did not notice any odors or bad smells from resident bedrooms or bathrooms. Based on interviews and observation, this allegation is unsubstantiated.

Due to the information mentioned above, all of these allegations are unsubstantiated at this time. No deficiencies were issued. This report was signed and delivered. An exit interview was conducted with the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4