198205039-7-10-2024-11-AS-UCOL-D8DN4S-20240822100826

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198205039
Report Date: 07/10/2024
Date Signed: 07/10/2024 03:14:15 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
07/01/2024 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20240701105401

FACILITY NAME:	ANGEL'S HAVEN II		FACILITY NUMBER:	198205039
ADMINISTRATOR:	OSCAR LECHUGA		FACILITY TYPE:	740
ADDRESS:	28022 ACANA ROAD		TELEPHONE:	(310) 544-4594
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY:	6	CENSUS: 4	DATE:	07/10/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	ADMINISTRATOR OSCAR LECHUGA		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff not permitting resident to have visitors without prior notice
Facility staff not providing adequate meal service to resident
Facility staff not assisting resident with ambulating as needed

INVESTIGATION FINDINGS:

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On 07/10/2024 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Angel’s Haven 2 and was greeted by Administrator Oscar Lechuga A1. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

The investigation consisted of the following: LPA Calderon interviewed Administrator (A1), Staff (S1-S2), interview resident (R1-R4) and interviewed Witness (W1). On 07/10/2024 LPA Calderon obtained and reviewed the following: Admission agreement (date 01/05/2024), preplacement appraisal (date 01/05/2024), Needs and service plan (date 01/05/2024), Physician report (date 10/25/2023), Client weight record (date 01/06/2024 to 06/01/2024), Divine Hospice Services (date 01/08/2024), facility meal plan for R1.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

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-20240701105401

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: ANGEL'S HAVEN II	FACILITY NUMBER: 198205039
	VISIT DATE: 07/10/2024

NARRATIVE

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Regarding Allegation #1: Facility staff not permitting resident to have visitors without prior notice. It is being alleged that facility staff did not permit resident to have a visitor without prior notice. The interviews indicate the following: A1 indicates that all resident family are welcome to visit anytime they want between the hours of 1pm to 8pm. A1 indicates that R1 family member was not asked to give notice prior to visiting R1. A1 indicates that staff would not refuse to allow residents from visiting. S1-S2 indicate that R1 family could visit between the hours of 1pm to 8pm weekly. S1-S2 indicate that staff did not prevent R1 family from visiting. 2 out of 4 residents indicate that their family could visit when they wanted, and staff would not prevent any family member from visiting a resident. 2 out of 4 residents were non-verbal due to health issues and could not be interviewed. W1 indicates that R1 family could visit any time they wanted, and staff would not prevent any visit. W1 indicates that facility staff did not advise that R1 family member had to ask for notice to visit prior to arriving at the facility. Reviewed Admission Agreement (date 01/05/2024) for R1. Admission agreement indicates that resident’s family can visit between 1pm and 8pm. There is no mention of resident family members having to call or give prior notice.

Regarding Allegation #2: Facility staff not providing adequate meal services to resident. It is being alleged that facility staff did not provide adequate food to resident. The interviews indicate the following: A1 indicates that every resident is given 3 meals and 3 snacks per day. A1 indicates that if a resident is hungry all the residents must do is ask for food and staff would provide extra food to eat. A1 indicates that no resident goes hungry. 2 out of 2 staff indicate that they provide 3 meals and 3 snacks per day and no resident goes hungry. 2 out of 4 residents indicate that staff serves them 3 meals and 3 snacks per day. 2 out of 4 residents indicate that staff serves them enough food and they do not go hungry. 2 out of 4 residents were non-verbal due to health issues and could not be interviewed. W1 indicates that R1 has never advised W1 that staff has not served R1 enough food to eat. W1 indicates that R1 has gained weight and R1 health is doing better. LPA Calderon reviewed the weekly meal plan and noted different meals per day and that 3 meals and 3 snacks are served. LPA Calderon toured the kitchen area and noted enough food to feed 4 residents and 3 staff for more than 7 days. LPA Calderon noted snacks were served to residents and lunch was served. Reviewed R1 client weight record (date 01/06/2024 to 06/01/2024), LPA Calderon noted that R1 gained eight pounds (LBS) in the six months R1 has been living at the facility.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20240701105401

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: ANGEL'S HAVEN II	FACILITY NUMBER: 198205039
	VISIT DATE: 07/10/2024

NARRATIVE

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Regarding Allegation #3: Facility staff not assisting resident with ambulating as needed. It is being alleged that facility staff did not move resident as needed. The interviews indicate the following: A1 indicates that R1 moved into the facility under hospice care. A1 indicates that R1 was non ambulatory and has cognitive issues. A1 indicates due to health issues R1 could not be moved without help. 2 out of 2 staff indicate that R1 was moved but could not walk. 2 out of 4 staff indicate that R1 was under hospice care and could not move as other residents. 2 out of 4 residents indicate that with help staff takes them for walks weekly. 2 out of 4 residents were non-verbal due to health issues and could not be interviewed. W1 indicates that when R1 moved into the facility R1 was on hospice care due to health issues and could not walk. W1 indicates that R1 cannot walk, and staff helps R1 move from the bed to the chair. W1 indicates that R1 health has improved since living at the facility for 6 months. Reviewed Physician Report (date 10/25/2023) for R1. Physician Report indicates that R1 was ambulatory and needed help with moving. Reviewed Divine Hospice Services (date 01/08/2024) for R1. Hospice services noted health issues for R1.

Based on interviews, observations and supporting documents. The preponderance of evidence standard has NOT been met; therefore, the allegation of “Facility staff not permitting resident to have visitors without prior notice” “facility staff not providing adequate meal service to resident”, “facility staff not assisting resident with ambulating as needed” is found to be UNSUBSTANTIATED.

A face-to-face meeting was conducted with Administrator Oscar Lechuga, and a hard copy was provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

LIC9099 (FAS) - (06/04)

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