198202004-7-1-2024-11-AS-SCIS-D732ZE-20240710175013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198202004
Report Date: 07/01/2024
Date Signed: 07/01/2024 02:11:40 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/24/2024 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240624135821

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; 6	CENSUS: 4	DATE:	07/01/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Vicenta Mendoza		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not ensure that the facility was kept clean.

INVESTIGATION FINDINGS:

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On 07/01/24, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint visit regarding the above allegation. LPA met with Licensee Vicenta Mendoza and explained the reason for the visit.

The investigation consisted of the following: LPA obtained a copy of the Resident Roster, Staff Roster, and toured the facility. Additionally, LPA interviewed staff #1-#3 (S1-S3), resident #1 (R1) and attempted to interview resident #2 (R2).

Investigation revealed the following: Regarding the allegation: Staff did not ensure that the facility was kept clean. It is alleged that the facility is filthy and overcrowded. On 07/01/24 LPA Gonzalez interviewed S1-S3, and (3) out of (3) staff denied the allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

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-20240624135821

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: ANGELS HOME CARE	FACILITY NUMBER: 198202004
	VISIT DATE: 07/01/2024

NARRATIVE

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When LPA asked staff how often is the facility cleaned, (3) out of (3) staff stated that the facility is cleaned daily and that it is deep cleaned every Friday. (3) out of (3) staff stated that the facility is not overcrowded and only the allowed residents are here. LPA interviewed R1 and attempted to interview R2. R1 stated that they are very comfortable living here at this facility and that staff make sure to always keep it clean and sanitary. R1 also stated that they have never had a problem with the facility not being clean or being overcrowded. LPA Gonzalez and Licensee, Vicenta Mendoza toured the facility inside and out. LPA did not observe the facility to be overcrowded. LPA observed the facility to be clean and sanitary.

Regarding the allegation “Staff did not ensure that the facility was kept clean,” based on LPA observation and interviews conducted, there was not enough supportive evidence to concur with the reported 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.

No deficiency was cited for this allegation. An exit interview was conducted, and a copy of this report was left with Licensee, Vicenta Mendoza.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

LIC9099 (FAS) - (06/04)

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