198202004-10-6-2022-11-AS-MVAO-CUYS89-20230823133842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198202004
Report Date: 10/05/2022
Date Signed: 10/06/2022 01:14:32 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
09/28/2022 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20220928172123

FACILITY NAME:	ANGELS HOME CARE		FACILITY NUMBER:	198202004
ADMINISTRATOR:	ANA GUTIEREZ LECHUGA		FACILITY TYPE:	740
ADDRESS:	28030 ACANA RD		TELEPHONE:	(310) 265-4994
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90274
CAPACITY:	6	CENSUS: 4	DATE:	10/05/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Oscar Lechuga		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Licensee did not ensure the facility was appropriately staffed with personnel with qualifications adequate to perform assigned tasks

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, October 05, 2022. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Caregiver Oscar Lechuga. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: LPA Bunker interviewed staff 1-3 (S1-S3). LPA Bunker asked questions relevant to the nature of the complaint. S1-S3 stated the facility is appropriately staffed with personnel qualifications adequate to perform assigned tasks. LPA Bunker was unable to interview residents 1-4 (R1-R4) they are all nonverbal. LPA Bunker requested and reviewed staff and residents' records. LPA Bunker requested copies of supporting documents.

See continued LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

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-20220928172123

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: ANGELS HOME CARE	FACILITY NUMBER: 198202004
	VISIT DATE: 10/05/2022

NARRATIVE

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Continued LIC812-C page 2

Allegation: Licensee did not ensure the facility was appropriately staffed with personnel qualifications adequate to perform assigned tasks
S1-S3 interviewed stated that they have the required knowledge for providing care and supervision needed to the residents. S1-S3 stated that they are given on-the-job training and have the appropriate experience which provides knowledge and skill to perform their jobs safely and effectively. S1-S3 stated that they are complying with Title 22 Regulations. S1-S3 stated residents are never left unattended. S1 Oscar Lechuga stated his grandmother is not providing care to the residents. S1-S3 stated staff is available 24 hours a day 7 days a week to assist residents in care with their daily needs.

Investigation revealed the following: LPA Bunker reviewed staff records and requested copies of supporting documents. During today’s visit, the facility was fully staffed. Residents were not left unattended. LPA observed staff at the facility interacting and engaging with the residents. S1-S3 stated they are receiving ongoing training. The facility staff is competent to provide the services necessary to meet individual client needs. S1-S3 stated the allegations are all false. S1-S3 denied the allegation.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the 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 deemed unsubstantiated.

There were no deficiencies cited.

Exit interview conducted.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

LIC9099 (FAS) - (06/04)

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