197800131-12-12-2023-11-AS-MVAO-CZCVSL-20240110154144

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197800131
Report Date: 12/12/2023
Date Signed: 12/12/2023 06:02:04 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
12/04/2023 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20231204113203

FACILITY NAME:	CHATEAU LONG BEACH		FACILITY NUMBER:	197800131
ADMINISTRATOR:	KHATERA BAHADORY		FACILITY TYPE:	740
ADDRESS:	3100 E. ARTESIA BLVD.		TELEPHONE:	(562) 428-5371
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY:	184	CENSUS: 88	DATE:	12/12/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Khatera Bahadory		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff are not adressing a resident hitting another resident.

INVESTIGATION FINDINGS:

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On 12/12/23 at 9:00am, Licensing Program Analyst (LPA) Lizeth Villegas conducted an initial complaint visit regarding the allegation above. LPA met with Administrator (A1) Khatera Bahadory as the purpose of today’s visit was explained.

The investigation consisted of the following: On 12/12 /23 LPA interviewed A1, staff #1-5 (S1-S5), witness #1 (W1), and interviewed residents # 2-9 (R2-R9). LPA obtained copies of the following for R1 and R2; facesheet, physicians report, physicians orders, preplacement appraisal information, needs and service plan, incident reports, and a staff and resident roster.
The investigation revealed the following:

Allegation- Staff are not addressing a resident hitting another resident.
It is being alleged that staff are not addressing a resident hitting another resident. On 12/12/23 LPA interviewed Administrator (A1) regarding the above allegation, A1 denied the allegation above stating

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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 11-AS-20231204113203

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: CHATEAU LONG BEACH	FACILITY NUMBER: 197800131
	VISIT DATE: 12/12/2023

NARRATIVE

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that no resident has disclosed being hit by another resident. Per A1, R2 resident uses his hands to move about the facility due to his visual impairment and R2 has no history of aggression. On 12/12/23, LPA interviewed S1—S5, 5 out of 5 staff interviewed denied the above allegation. 5 of 5 staff interviewed stated they did not have any knowledge of any resident being hit by another resident. On 12/12/23 LPA interviewed R2-R9 regarding the above allegations, 8 out of 8 residents interviewed denied the allegation and reported feeling safe at the facility. LPA was unable to interview R1 as R1 is no longer at this facility; however, LPA was able to interview W1 via telephone.

On 12/12/23 LPA Conducted review of R2’s physician’s report and there was no aggression nor behavioral concerns listed.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview conducted with Administrator (A1) Khatera Bahadory, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

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