198300069-7-25-2024-11-AS-JHAD-D8E2JQ-20240822172639

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198300069
Report Date: 07/25/2024
Date Signed: 07/25/2024 03:29:00 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
07/19/2024 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20240719104917

FACILITY NAME:	MONROE CARE SOLUTIONS		FACILITY NUMBER:	198300069
ADMINISTRATOR:	MONROE, CARLISS		FACILITY TYPE:	735
ADDRESS:	1442 WEST VERNON AVE		TELEPHONE:	(323) 309-5399
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90062
CAPACITY:	6	CENSUS: 6	DATE:	07/25/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Carliss Monroe, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not prevent a client from attacking another client

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 7/25/24 Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced subsequent complaint visit. LPA met with Carliss Monroe, Administrator and explained the purpose of today's visit and was granted entry.

The investigation consisted of the following: On 7/25/24 LPA Shirley reviewed resident files and conducted interviews with staff and clients. LPA also requested and reviewed and made copies of the following records: Staff Roster, Id and Emergency Info, Preplacement Appraisal, and Physician’s Reports.

Investigation revealed the following:

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024

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 2

Control Number 11-AS-20240719104917

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: MONROE CARE SOLUTIONS	FACILITY NUMBER: 198300069
	VISIT DATE: 07/25/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff did not prevent a client from attacking another client

The complainant alleges that staff is not preventing clients from attacking each other. LPA reviewed an incident report in which there was an altercation on 7/14/24 between two clients. During interviews, LPA learned that C1 was unable to sleep due to psych episodes of C2, their roommate. C1 tried to report their frustration with C2 to S3. C1 became aggressive verbally and physically towards client and staff. C1 is legally blind and could not recall the roommates name. C1 began swinging their walking cane striking S3 as S3 tried to defuse the situation by separating both clients as witnessed by C5. Per C5, C1 did not know who was who as he was just trying to defend himself. The police were called by staff and staff was advised to separate the roommates by changing their rooms.

LPA Shirley interviewed staff 1-3 (S1-S3), and asked, does staff prevent a client from attacking another client? Of those interviewed, 3 out of 3 answered yes. LPA Shirley interviewed clients 1-6 (C1-C6). LPA ask, does staff prevent a client from attacking another client. Of those interviewed, 4 out of 6 answered yes.

Based on information gathered, the department did not find sufficient evidence to support allegation of, "Staff did not prevent a client from attacking another client”. 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 and a copy of the LIC 9099 was provided to Administrator, Carliss Monroe.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2