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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197803676
Report Date: 04/02/2022
Date Signed: 04/29/2022 02:36:08 PM

Substantiated


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
12/17/2021 and conducted by Evaluator Nune Margaryan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211217084701
FACILITY NAME:STRIDEFACILITY NUMBER:
197803676
ADMINISTRATOR:HUNT, RENEE DENISEFACILITY TYPE:
735
ADDRESS:2059 RAELYN PLACETELEPHONE:
(626) 961-5101
CITY:WEST COVINASTATE: CAZIP CODE:
91792
CAPACITY:6CENSUS: 5DATE:
04/02/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Staff Alongia JenkinsTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Resident's dental needs not met while in care.
INVESTIGATION FINDINGS:
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This is an amended LIC9099 that delivered on 04/02/2022. The report was amended to correct information on the narrative. Corrected information does not change the findings. Complaint remains Substantiated. LPA Nune Margaryan redelivered amended report and obtained signature on 04/29/22.

Licensing Program Analyst (LPA) Nune Margaryan conducted a subsequent complaint visit to deliver findings on the allegation listed above. LPA met with staff Alongia Jenkins and explained of purpose of visit.
The initial visit was conducted by LPA Nune Margaryan on 12/27/2021. During the visit, LPA interviewed manager Maria Rios and obtained copies of relevant documents. It was alleged that on 12/18/2020 the facility client #1 (C1) was recommended by the dentist to see a periodontist and staff forgot about it and didn't follow up.

Continue 9099C

Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
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-20211217084701
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: STRIDE
FACILITY NUMBER: 197803676
VISIT DATE: 04/02/2022
NARRATIVE
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The Administrator and Manager admitted that on 12/18/2020 the dentist recommended C1 to get authorization to attend periodontist for referral and they forgot to follow up.
Upon review of facility documents regarding C1’s dental appointments LPA noted that no follow up appointment was made to see periodontist as it was recommended by the dentist.
Based on interviews and documents review it was concluded that the staff did not provide required incidental dental care to C1. Therefore, the allegation is substantiated at this time.

Under Title 22 Regulations, following citation was issued and recorded on LIC 9099D.
Exit interview was conducted and a copy of report and appeal rights were issued.





NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20211217084701
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: STRIDE
FACILITY NUMBER: 197803676
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/04/2022
Section Cited
CCR
80075(a)
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Health Related Services. The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services.


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The licensee will provide written statement. Indicating that moving forward, she will ensure that the medical and dental appointments as well as follow ups will be completed in timely manner.
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This requirement is not met as evidenced by; the facility client #1 (C1) had an appointment with periodontist and the staff forgot about it, and did not take C1 to the scheduled appointment. This poses an immediate health, safety risk to the clients 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.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3