198201097-8-12-2022-11-AS-EMAZ-CK6VW8-20221013164730

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198201097
Report Date: 08/01/2022
Date Signed: 08/12/2022 01:47:00 PM

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
07/19/2022 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220719162624

FACILITY NAME:	HARRISON'S BOARD & CARE HOMES,INC.		FACILITY NUMBER:	198201097
ADMINISTRATOR:	ANABELLE HARRISON		FACILITY TYPE:	735
ADDRESS:	20108 BELSHAW AVENUE		TELEPHONE:	(310) 554-4210
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY:	6	CENSUS: 5	DATE:	08/01/2022
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Anabelle Harrison		TIME COMPLETED:	10:57 AM

ALLEGATION(S):

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Staff caused the resident to fall.
Staff dragged the resident.

INVESTIGATION FINDINGS:

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On 08/01/22 Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent an unannounced complaint visit at this facility. LPA Dabuet was greeted by caregiver Irma Farjardo. Farjardo contacted licensee and administrator Anabelle Harrison by telephone. LPA Dabuet met with the administrator and explained the purpose of today's visit.

The investigation included the following; A review of the Client roster, Staff roster, Face sheets, ID/Emergency, Individual Personal Plan, Medical Progress Notes, Medication Administration Records, and other pertinent documents associated with client #1 (C1). A collateral visit at Advocacy For Respect and Choice Day Program. Interviews were conducted with clients #1- #5 (C2-C5) and witnesses #1 - #2 (W1-W2). A tour of the facility was conducted.

Evaluation Report continues on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022

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 11-AS-20220719162624

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: HARRISON'S BOARD & CARE HOMES,INC.	FACILITY NUMBER: 198201097
	VISIT DATE: 08/01/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff caused the resident to fall.
Staff dragged the resident.

The details of the complaint alleged client #1 (C1) was physically abused by staff. The complainant reported that (C1) had fallen while being assisted into his home and was not helped immediately. The complainant added that (C1) was not properly handled and was dragged inside the home by the staff. The Department interviewed the complainant who later retracted the accusations as untrue and unjustified. The complainant states a complete investigation determined the allegations of physical abuse are not supported.

Staff #1 (S1) investigated this incident that occurred on 05/06/22. (C1) fell on a small step that led into the entry porch. Because (C1) suffers from a health condition, the staff did not act immediately to help when he fell. The staff allowed him to compose himself before picking him up from the ground. The staff remained by his side the entire time. According to (S1), (C1) was not dragged into the house with his walker, but was rather helped by staff from the front and rear with is walker. As described, the first staff assisted and guided him from the front of his walker, and the second staff assisted him from behind holding onto is lumber back. (S1) reveals that the staff did not mishandle or disrespect (C1) throughout this process. Interviews with witnesses #1 - #2 (W1-W2) determined no evidence to support these allegations. (W1) power of attorney for (C1) states (C1) has been cared for at this facility for 26 years and he had no concerns for his health or safety at this facility. (W1) added that he had planned for (C1) would live the rest of his life at this home. However, it has been determined this facility can no longer meet his needs based on the level of care. (W2) reports that (C1) has been attending the day program for six years, and did not have any uncertainties for (C1)’s well-being living at this facility. Interviews conducted with staff #2-#3 (S2-S3) both directly involved during the incident claim these accusations are untrue. (S2-S3) report the fall was an accident and that (C1) was supported and escorted into the home properly.

Evaluation Report continues on LIC 9099C
This report serves as an amendment to clarify finding line 13-27. It does not supersedes the complaint investigation findings reflected on report created: 08/01/22.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220719162624

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: HARRISON'S BOARD & CARE HOMES,INC.	FACILITY NUMBER: 198201097
	VISIT DATE: 08/01/2022

NARRATIVE

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(S2-S3) claims the report that they both maliciously laughed at (C1) when he fell is also fictitious as both staff members were wearing a surgical mask during the incident. It would be difficult to determine their facial reactions. (S1-S3) states (C1) had no scrapes, bruises, or injuries from the fall and that medical attention was not required. The Department reviewed clients #1-#6 (C1-C6) service records and attempted to interview (C1-C5) who were present at the facility and were unable to hold a conversation as a result of their disability. (C6) was not available for an interview as she was under isolation.

The facility did its due diligence and notified immediately all agencies including Community Care Licensing (CCL), South Central Los Angeles Regional Center (SCLAR), and family representatives. (SCLARC) Quality Assurance investigated this case and found no evidence to reflect any physical abuse.

Based on information gathered, an inspection of the facility, observation, analysis of (C1)'s service records, and interviews conducted, the Department found no evidence to support the allegations mentioned in this complaint.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

No deficiencies were cited during this visit.

An exit interview was conducted with Anabelle Harrison, and a copy of the report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022

LIC9099 (FAS) - (06/04)

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