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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197800725
Report Date: 11/16/2021
Date Signed: 11/16/2021 05:16:34 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 DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/20/2021 and conducted by Evaluator Martessa Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20210120083215
FACILITY NAME:GRACE CARE CORPORATIONFACILITY NUMBER:
197800725
ADMINISTRATOR:AARON, RUTHFACILITY TYPE:
735
ADDRESS:317 E. 189TH ST.TELEPHONE:
(310) 527-2018
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:6CENSUS: 4DATE:
11/16/2021
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Marie Spencer, ManagerTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility staff slap resident(s) in care.
Facility staff yell at resident(s) in care.
INVESTIGATION FINDINGS:
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On 11/16/21, Licensing Program Analyst (LPA) Martessa Brown conducted a subsequent complaint visit in order to render investigation findings. During today’s visit LPA met with Marie Spencer, Facility Manager and the purpose of the visit was explained.

The investigation consisted of the following: On 1/27/21 LPA Brown toured the physical plant and requested the following documents, client & Staff Roster, clients records, Admission Agreements, Physicians Report’s, Behavior plans, Medication List, Emergency Contacts, Staff Training Records and pertinent Incident reports.
The investigation revealed the following:

Regarding allegation: Facility staff slap resident(s) in care.

On 11/15/21 LPA conducted Interviews with Administrator Stephanie R. Aron and Staff S1, they stated the police were called to the facility on 1/17/21.

LIC 9099-C is on the next page
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
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 5
Control Number 11-AS-20210120083215
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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GRACE CARE CORPORATION
FACILITY NUMBER: 197800725
VISIT DATE: 11/16/2021
NARRATIVE
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Administrator stated Carson Police department was sent to check on residents. She stated the police checked all residents and they appeared to be fine and no report was made. Administrator and S1 stated they have not physically abused or witness staff being physical to clients. On 11/16/21 LPA conducted interviews with Staff S2-S4, staff stated they were aware police were called to the facility to check on residents but there were no problem and police had left. Staff stated Clients C1 will yell out frequently to stop hitting me C1 and C2 will clap hands all the time very loud and that’s part of their behavior problem. Staff stated they have not physically touch clients while in care.

Facility staff yell at resident(s) in care.

On 11/15/21 LPA conducted Interviews with Administrator Stephanie R. Aron and Staff S1, they stated have not raised their voice, but some staff will have to speak firm to some clients in order to listen. On 11/16/21 LPA conducted interviews with Staff S2-S4, staff stated they have not raised their voices to residents in care and have not witness another staff.

LPA reviewed C1-C2 Behavior Reports and descriptions does not mention the above behavior problems that staff has mentioned but mentioned other conditions.

Based on interviews conducted and records review, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.



An exit interview was conducted with Stephanie Aaron, and a hard copy was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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 DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/20/2021 and conducted by Evaluator Martessa Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20210120083215

FACILITY NAME:GRACE CARE CORPORATIONFACILITY NUMBER:
197800725
ADMINISTRATOR:AARON, RUTHFACILITY TYPE:
735
ADDRESS:317 E. 189TH ST.TELEPHONE:
(310) 527-2018
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:6CENSUS: 4DATE:
11/16/2021
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Marie Spencer, ManagerTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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2
3
4
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9
Facility staff speak inappropriately to resident(s) in care.
Facility is in disrepair.
INVESTIGATION FINDINGS:
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13
On 11/16/21, Licensing Program Analyst (LPA) Martessa Brown conducted a subsequent complaint visit in order to render investigation findings. During today’s visit LPA met with Marie Spencer, Facility Manager and the purpose of the visit was explained.

The investigation consisted of the following: On 1/27/21 LPA Brown toured the physical plant and requested the following documents, client & Staff Roster, clients records, Admission Agreements, Physicians Report’s, Behavior plans, Medication List, Emergency Contacts, Staff Training Records and pertinent Incident reports.

The investigation revealed the following:

Facility staff speak inappropriately to resident(s) in care.

On 11/15/21 LPA conducted Interviews with Administrator Stephanie R. Aron and Staff S1, they stated they have not cursed or teased clients and have not heard any staff do this to clients while in care.

LIC 9099-C is on the next page
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20210120083215
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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GRACE CARE CORPORATION
FACILITY NUMBER: 197800725
VISIT DATE: 11/16/2021
NARRATIVE
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On 11/16/21 LPA conducted interviews with Staff S2-S4, 3 out of 4 staff they stated have not cursed or teased clients and have not heard any staff do this to clients while in care. One staff stated while giving C1 a shower that the client screams. Staff stated would try to calm client down by stating " if you are not quiet, you will not eat breakfast and the client calms down.

LPA reviewed C1-C2 Behavior Reports and Interventions for clients.

Allegation: Facility is in disrepair.



On 11/15/21 LPA conducted Interviews with Administrator Stephanie R. Aaron and Staff S1, they stated in the backyard there are missing bricks but there is plywood to cover the space. On 11/16/21 LPA conducted interviews with Staff S2-S4, 3 out of 4 staff stated they notice the plywood covering the bricks. LPA observed at 1:30 PM, in the backyard brick were missing on left side and plywood with with a trash bin holding the wood in place.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 deficiencies are being cited on the attached LIC 9099-D.

Exit Interview Conducted, appeal rights were explained and a copy of this report was furnished to Stephanie Aaron.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20210120083215
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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GRACE CARE CORPORATION
FACILITY NUMBER: 197800725
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2021
Section Cited
CCR
85072(a)(1)
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85072 Personal Rights
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(1) To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement was not met as evidence by:


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Licensee will review Personal Rights regulation
and will train all staff regarding on personal rights and interventions. Licensee will review intervention plan for resident and
contact regional center to have a curent plan and will send training doucments. Licensee will send nto LPA by POC date 11/30/21.
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Based on LPA observation one staff stated while giving C1 a shower that the client screams and will calm resident down by stating will eat breakfeast.

This is a potenial/immediate health & saftey risk to residents in care.

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Type B
12/16/2021
Section Cited
CCR
80087(a)
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80087
Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors

This requirement was not met as evidence by:
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Licensee will review regulation and remove plywood and have brick fixed in back yard and will send proof to LPA by POC due date 12/16/21.
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Based on LPA observation
PA observed at 1:30 PM, in the backyard brick were missing on left side and plywood with with a trash bin holding the wood in place.

This is a potenial/immediate health & saftey risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5