198201903-10-15-2022-11-AS-MVAO-CKCQ7X-20221019115554

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198201903
Report Date: 10/14/2022
Date Signed: 10/15/2022 08:04:56 AM

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
09/13/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220913115832

FACILITY NAME:	GRACE CARE CORPORATION		FACILITY NUMBER:	198201903
ADMINISTRATOR:	AARON, RUTH		FACILITY TYPE:	735
ADDRESS:	2417 WEST 154TH STREET		TELEPHONE:	(310) 537-2018
CITY:	COMPTON	STATE: CA	ZIP CODE:	90220
CAPACITY:	6	CENSUS: 2	DATE:	10/14/2022
		UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Ruth Johnson, Care giver		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility delayed medical treatment for resident's condition.
Staff are not ensuring that the facility is free from vermin.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Today’s complaint investigation was conducted with Ruth Johnson, Care giver.

The investigation consisted of following: Interviews and Record reviews. On 09/16/22, LPA Soto interviewed Administrator, S#2, and S#3, C#1 & C#2. LPA and Administrator toured the entire facility (seeing fans and A/C that was operational) and LPA did see a couple of dead roaches in the kitchen. The facility was treated today 09/16/22 for pest by Terminix Pest Control. LPA requested and received the following documents on 09/16/22: Face sheet, Medical Reports from 09/10/22, Pre-Appraisals, Physician's Report, IPP, Semi Annual report, Quarterly Report, Admission agreement, Psychological report, Child evaluation, ID/emergency numbers, Copy of Terminix Pest Control invoice, Mars (August and September) and any Incident Reports involving client #1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

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-20220913115832

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: 198201903
	VISIT DATE: 10/14/2022

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following:

Allegation 1 – Facility delayed medical treatment for resident's condition. According to RP C#1 his foot issue was severe. Interviews with administrator and S#2-S#3, communicated that C#1 foot had some sort of fungus/eczema. The were applying cream for the dryness, C#1 did not complain of pain or discomfort. Administrator believed that C#1 continued issue was because C#1 showered and did not let foot air dry before putting on socks and that’s why his eczema/fungus would not get better. On 09/10/22, C#1 was taken to see C#1 physician(podiatrist) doctor issued cream for the eczema/fungus. Staff was applying as directed. On 09/28/22, C#1 went back to podiatrist for follow up. Again, doctor prescribed same medication and the eczema/fungus was getting better. LPA attempted to interview clients; client’s mental status did not allow them to answer LPA’s questions. LPA reviewed the medical documents dated 09/10/22 from Podiatrists for C#1 it states that it looked better and prescribed medication (ointment.) The interviews and records reviews do not concur with the above allegation.

Allegation 2 - Staff are not ensuring that the facility is free from vermin. According to RP the facility is infested with cockroaches. Administrator communicated that administrator saw a few cockroaches and hired pest control company to treat the entire facility. The pest control company came to treat the facility on 09/16/22. S#2 communicated that S#2 had not seen any cockroaches in the facility. S#3 communicated S#3 had seen cockroaches in the kitchen and advised administrator about the cockroaches. LPA attempted to interview clients; client’s mental status did not allow them to answer LPA’s questions. LPA toured the entire facility to observe if there were any cockroaches in the facility. LPA did see a couple of dead roaches in the kitchen. The facility provided a copy of pest control invoice, which showed that the facility had been treated for pest. The facility did treat the facility and was ensuring that the facility was free of vermin. The interviews and records review do not concur with the above allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated

An exit interview was conducted with Ruth Johnson, care giver, and a hard copy of report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

LIC9099 (FAS) - (06/04)

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