198204651-12-28-2022-11-AS-MVAO-CN7RXK-20230118122451

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204651
Report Date: 12/28/2022
Date Signed: 12/28/2022 11:19:37 AM

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
12/22/2022 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221222163507

FACILITY NAME:	HEARTS OF PARADISE HOME		FACILITY NUMBER:	198204651
ADMINISTRATOR:	BESSIE L COELLO		FACILITY TYPE:	740
ADDRESS:	4139 W. 177TH ST.		TELEPHONE:	(310) 371-7950
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90504
CAPACITY:	6	CENSUS: 6	DATE:	12/28/2022
		UNANNOUNCED	TIME BEGAN:	09:29 AM
MET WITH:	Bessie L Coello		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility staff did not allow family member get resident’s belongings.

INVESTIGATION FINDINGS:

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On 12/28/22 at 9:29am, Licensing Program Analyst (LPA) Perry Scott and Licensing Program Manager (LPM) Janae Hammond initiated a complaint investigation regarding the allegation above. We were met by Ada Diaz, caregiver, who then contacted the administrator Bessie L. Coello. The administrator arrived about fifteen minutes later to assist with the visit.

The investigation consisted of the following:

On 12/28/2022 at 9:50am, we interviewed the administrator (staff 1) and staff 2-3. LPA obtained copies of resident/staff rosters, inventory sheet, admission agreement, special incident report, physician’s notes, other pertinent documents, and copies of written correspondence between responsible parties. On 12/27/22 LPA conducted interviews with witness 1- 3.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

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-20221222163507

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: HEARTS OF PARADISE HOME	FACILITY NUMBER: 198204651
	VISIT DATE: 12/28/2022

NARRATIVE

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LPA interviewed administrator Bessie L. Coello about the allegation. She stated that resident 1’s family member decided to move R1 out of the facility on 12/09/22 because R1 was on hospice and declining. The interview with the administrator revealed that the family moved out R1 on 12/09/22 and returned on 12/19/22 to pick up R1’s belongings.

LPA interviewed S2-S3, and all staff denied the allegation and confirmed R1’s family picked up the residents personal belongings.

On 12/28/2022 LPA reviewed R1’s record and the review of the record revealed that an inventory of the resident’s belongings was done prior to admittance and prior to the family picking up the belongings on 12/19/22. LPA further observed a signed inventory sheet by the family for the belongings.

On 12/27/22 LPA conducted interviews with W1-W3, and 3 of 3 confirmed that R1’s personal belongings were picked up. LPA was unable to interview R1 because R1 is deceased. Based on interviews, observations, and records review there was insufficient 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 unsubstantiated.

Exit interview was conducted with Bessie L Coello, administrator, and a copy of the report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC9099 (FAS) - (06/04)

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