198320029-5-18-2022-11-AS-JHAD-CGS2GU-20220728172344

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320029
Report Date: 05/18/2022
Date Signed: 05/18/2022 06:19:40 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/16/2022 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220516144009

FACILITY NAME:	HELEN-ANNE RESIDENTIAL CARE		FACILITY NUMBER:	198320029
ADMINISTRATOR:	FORT, NISHA		FACILITY TYPE:	735
ADDRESS:	712 LACONIA PL		TELEPHONE:	(213) 293-5101
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90044
CAPACITY:	4	CENSUS: 3	DATE:	05/18/2022
		UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	NEISHA FORT		TIME COMPLETED:	02:59 PM

ALLEGATION(S):

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Resident is being physically abused while in care.
Resident is being verbally abused while in care.

INVESTIGATION FINDINGS:

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On 05/18/22, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced complaint investigation visit at this facility, LPA was greeted by Niesha Brown-Pennel and Naida Palmer direct support providers who contacted Niesha Fort the administrator. Fort arrived and LPA explained the purpose of today's visit.

The investigation consisted of the following: LPA interviewed staff #1-#3 (S1-S3), clients #1-#2 (C1-C2), witnesses #1-#4. A review of (C1's) service records and other pertinent documents relevant to the nature of the complaint. A reviewed of Los Angeles Police Department statement. A tour of the facility.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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-20220516144009

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HELEN-ANNE RESIDENTIAL CARE	FACILITY NUMBER: 198320029
	VISIT DATE: 05/18/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Resident is being physically abused while in care.
Resident is being verbally abused while in care.

During this investigation, LPA reviewed C-1's service records and interviewed staff #1-#3 (S1-S3), clients #1-#2 (C1-C2), and witnesses #1-#4 (W1-W4) and found there is no evidence to support the allegations mentioned above.

It was alleged that client #1 (C1) is being physically and verbally abused while in care. The complainant claims (C1) is a victim of sexually assaulted on the street and was transported to Harbor UCLA Hospital on
05/13/22 through 05/16/22 for medical observations. The complainant did not have detailed information on the suspect, when, where, or how it happened. An interview with staff #1 -#3 reports that (C1) had left the facility at around 8:24 pm on 05/13/22 and failed to return and was notified the client was at the hospital for observation. (S1) states that (C1) had contacted The Los Angeles Police Department to assist with the transport to the hospital. (S1) states that (C1) denied any sexual assault had taken place with law enforcement and the hospital. An interview with (C1) verified that she was not sexually assaulted during the time of 05/13/22-5/16/22. (C1) declined to provide additional information about the alleged incident and was unable to focus on the interview and questions. Furthermore, (C1) confirms there has been no physical or verbal abuse in recent times. (C1) kept referring to an incident that occurred in December 2021 for both of these allegations and did not seek medical attention for her injuries. These allegations are under investigation with Community Care Licensing (CCLD) control number 11-AS-20211215141451. (C1) claims she had evidence of physical and verbal abuse by staff but is unable to provide pieces of evidence that abuse is carried out while in care. (C1) was not specific with details nor had photographs or video to support her claim. On 05/17/22 Josie Cortines of the Los Angeles Police Department was dispatched to the home to investigate a dispute. According to the officer on 05/17/22 at 1350 a radio call about a battery. Officer spoke with the victim (C1) whose alleged caretakers attempt to enter her room without her permission. No crime occurred at the time of dispute only. Interviews with witnesses #1-#3 (W1-W3) all report there have been no immediate health or safety concerns with (C1's) well-being and that all her needs and services are addressed appropriately.

Evaluation Report continues on LIC 9099-C

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220516144009

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HELEN-ANNE RESIDENTIAL CARE	FACILITY NUMBER: 198320029
	VISIT DATE: 05/18/2022

NARRATIVE

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Interviews with staff #1-#3 (S1-S3) all denied the allegations and stated these allegations are untrue and fabricated. Interviews with (S2-S3) claim that the have completed DPS training and have the knowledge and experience how to handle behavioral crises. An interview with (S1) added she is certain there is no foul play from staff. The Department unable to interview client #2 (C2) as she declined to participate, and client #3 (C3) was on a community service with no communications available.

Based on information gathered, observation, interviews, service records, and other pertinent resources reviewed, there is no evidence to support the allegations,"Resident is being physically abused while in care" and "Resident is being verbally abused while in care".

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22.

An exit interview was conducted with Neisha Fort and a copy of the report was provided.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC9099 (FAS) - (06/04)

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